Advances in pediatric heart transplantation
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1Saint Louis University Health Sciences Center and Cardinal Glennon Children's Medical Center, 1465 S. Grand Boulevard, St Louis, MO 63104, USA. schowko@slu.edu
Insights
Pediatric heart transplantation offers good quality of life, but long-term survival remains a challenge. New immunosuppressants may improve outcomes by reducing complications like kidney dysfunction and transplant vasculopathy.
Area of Science:
- Pediatric Cardiology
- Transplant Immunology
- Immunosuppressive Therapy
Background:
- Pediatric heart transplantation is a viable option for end-stage heart failure and complex congenital heart defects.
- Conventional surgical interventions are not always suitable for these complex cases.
Purpose of the Study:
- To review the current status of pediatric cardiac transplantation.
- To discuss recent advancements and emerging therapies in the field.
Main Methods:
- Literature review of pediatric cardiac transplantation studies.
- Analysis of recent advances in immunosuppressive therapies and their impact.
Main Results:
- Significant improvements in early mortality and short-term survival rates since the 1980s.
- High quality of life reported for most pediatric transplant recipients.
- Long-term mortality remains a challenge, primarily due to transplant-related coronary artery disease and graft failure.
- Renal dysfunction and posttransplant lymphoproliferative disorders are significant late morbidities linked to immunosuppression.
- Newer immunosuppressive agents (sirolimus, everolimus) show promise in mitigating long-term complications.
Conclusions:
- Novel immunosuppressive drugs offer potential to minimize renal complications and influence transplant vasculopathy progression.
- Advances in understanding posttransplant lymphoproliferative disorders are expected to improve diagnosis and treatment.
Purpose Of Review:
Heart transplantation has become a reasonable treatment option for pediatric patients with end-stage heart failure or complex congenital cardiac defects not amenable to conventional surgical intervention. This review will summarize the current state of pediatric cardiac transplantation and review recent advances leading to new therapies.
Recent Findings:
Improvements in early mortality after cardiac transplantation have occurred consistently over time since the 1980s, short-term survival rates are high, and most patients enjoy an excellent quality of life with minimal restrictions. The reduction of late mortality is still a major challenge, however, largely as a result of transplant-related coronary artery disease causing chronic graft failure and arrhythmogenic sudden death. Additional causes of morbidity and mortality occurring late after transplantation include renal dysfunction related to chronic immunosuppressive therapy with calcineurin inhibitors (tacrolimus or cyclosporine) and posttransplant lymphoproliferative disorders related to chronic immunosuppression. Newer agents (sirolimus, everolimus) have shown promise in immunosuppressive regimens that may alter the development or progression of long-term complications.
Summary:
New immunosuppressive agents allow alterations in drug regimens to minimize renal complications, and may influence the incidence and progression of transplant vasculopathy. Recent studies on posttransplant lymphoproliferative disorders should result in earlier diagnosis and therapy.
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