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[Heart transplant: when the candidate is a child]
Silvia Favilli1, Gaia Spaziani1, Iva Pollini1
1S.O.D.C. Cardiologia Pediatrica, Azienda Ospedaliero-Universitaria Meyer, Firenze.
Insights
Heart transplantation (HT) is a vital therapy for pediatric end-stage heart failure (HF). Careful evaluation is crucial due to diverse pediatric heart conditions and potential contraindications to HT.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Transplantation Medicine
Context:
- Heart transplantation (HT) has been a recognized therapy for pediatric end-stage heart failure (HF) for over 40 years.
- Pediatric HF patients are a diverse group with various congenital or acquired heart conditions.
- Advancements in cardiac surgery and medical treatments necessitate ongoing reassessment of HT indications.
Purpose:
- To discuss the evolving indications for heart transplantation in pediatric patients with heart failure.
- To highlight factors that may contraindicate HT in children, such as systemic diseases and genetic syndromes.
- To review common pediatric heart diseases that may warrant HT and prognostic factors in pediatric HF.
Summary:
- Pediatric end-stage heart failure (HF) management includes heart transplantation (HT), a therapy with a long history.
- Patient heterogeneity, encompassing diverse congenital and acquired heart diseases, requires tailored HT evaluations.
- Contraindications like systemic diseases, metabolic disorders, genetic syndromes, and extra-cardiac malformations must be considered.
Impact:
- Informs clinical decision-making regarding the suitability of heart transplantation for pediatric HF patients.
- Guides the assessment of complex pediatric cases with potential contraindications to HT.
- Contributes to the understanding of prognostic parameters and indications for HT in pediatric cardiology.
Abstract:
Heart transplant (HT) has been considered as a therapy for pediatric end-stage heart failure (HF) for more than four decades. Children with HF represent a very heterogeneous population, affected by different congenital or acquired heart diseases. Progresses in cardiac surgery and medical therapies, leading to improved prognosis, require periodic re-assessment of indications to HT. Systemic diseases, inherited inborn errors of metabolism, genetic syndromes or associated extra-cardiac malformations can contraindicate HT. In these conditions a tailored evaluation is needed. Pediatric heart disease, which more often may be an indication to HT, as well as prognostic parameters in pediatric HF are discussed.