[Transplantation cardiaque pédiatrique : quel futur ?]

The future of pediatric heart transplantation. Pediatric heart transplantation developed in the 1980s, following the introduction of cyclosporine. The International Registry includes more than 14 000 patients (10 % of the whole). The results improved progressively. However, two drawbacks persist : a shortage of donors, particularly in infants and a high morbi-mortality on the long term. The rapid achievement of a pediatric artificial heart is unlikely. The future offers two directions. Firsly xenotransplantation : the production of genetically-modified pigs and new immuno-suppressive modalities allow long-term survival in heterologous pig/primate transplantation. Human clinical trials may begin soon, particularly in neonates. Secondly tissue engineering : constant advances (scaffolds, cells lines, growth factors) may make possible the production of a functional heart from the receivor's own stem-cells.