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A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
Five decades of pediatric heart transplantation: challenges overcome, challenges remaining
1aHeart Transplant and Heart Failure, Phoenix Children's Hospital, Phoenix bChild Health, University of Arizona College of Medicine, Tucson, Arizona, USA.
Insights
Pediatric heart transplantation is crucial for end-stage heart failure. Advances in ventricular assist devices (VADs) and diagnostics are essential for improving long-term outcomes in children.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Medical Technology
Background:
- Pediatric heart transplantation remains the primary treatment for end-stage heart failure in children.
- Limited donor availability necessitates advancements in alternative therapies and management strategies.
Purpose of the Study:
- To review the evolving diagnostic and therapeutic landscape for pediatric heart transplantation.
- To highlight the importance of understanding new technologies and management protocols for practitioners.
Main Methods:
- Review of existing literature, including single-center series and registry data.
- Inference from adult studies and ongoing pediatric research collaborations.
- Analysis of technological advancements in ventricular assist devices (VADs) and diagnostic assays.
Main Results:
- Pediatric heart transplant outcomes are progressively improving.
- Ventricular assist device (VAD) technology and utilization are advancing.
- Refined diagnostic assays aid in managing donor-specific antibodies and rejection.
Conclusions:
- Clinicians must adapt to new technologies and management strategies for pediatric heart transplantation.
- Expertise in retransplantation and adult congenital heart disease care is increasingly vital.
- Continuous learning regarding antibody-mediated rejection and donor-specific antibodies is critical.
Purpose Of Review:
Pediatric heart transplants continue to be the therapy of choice for children with end stage heart failure. The interplay of limited donor supply, improvement in ventricular assist device (VAD) technology and utilization, and a focus on optimizing long-term outcomes make it critically important for practitioners to be aware of an evolving diagnostic and therapeutic arsenal.
Recent Findings:
Data suitable to define best practices for pediatric heart transplantation consist of an amalgam of small single center series, registry reviews and judicious inference from adult studies. Large-scale prospective pediatric studies are essentially nonexistent; the pediatric heart transplant study group continues to be highly productive while new collaboratives are emerging.
Summary:
Outcomes for pediatric transplants continue to improve. Technology and innovation continue to drive shifts in management. Improvements in VAD support along with refinement of solid-phase assays require clinicians to develop a deeper understanding of pre and post transplant management of donor-specific antibodies and antibody-mediated rejection. Expertise in retransplantation and the care of adults with congenital heart disease will be critical in the future.
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