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Published on: February 14, 2022
Pediatric heart transplantation: Current status and perspectives
Estela Azeka1, Fabiane Hase1,2, Yoshihiro Tomimoto1,3
1Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Insights
Pediatric heart transplantation (HT) has evolved significantly, offering improved survival and quality of life for children with end-stage heart disease. Ongoing research and innovations promise further advancements in care and life expectancy.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Cardiovascular Surgery
Background:
- Heart transplantation (HT) is the primary treatment for pediatric end-stage heart disease.
- Significant advancements in HT since 1967 have led to increased transplant numbers and improved survival rates.
Purpose of the Study:
- To review the current status of pediatric heart transplantation.
- To analyze epidemiology, ventricular assist device use, transplant numbers, and outcomes.
- To discuss pre-transplant issues, donor shortages, and innovative strategies like xenotransplantation.
Main Methods:
- Review of current pediatric heart failure epidemiology.
- Analysis of ventricular assist device and heart transplant statistics.
- Discussion of pre- and post-transplant management, including multidisciplinary teams and novel donor sources.
Main Results:
- Pediatric heart transplantation outcomes have improved over time.
- Key post-transplant considerations include immunosuppression, patient transition, and adherence.
- Telemedicine is emerging as a valuable tool for patient surveillance.
Conclusions:
- Pediatric heart transplantation is an established and effective treatment for end-stage heart disease.
- Advances in research and innovation are enhancing patient quality of life and life expectancy.
- Future innovations hold promise for further improving care for pediatric HT patients.
Background:
Heart transplantation (HT) has been the treatment of choice for children with end-stage heart disease. Since the first transplant in 1967, almost 6 decades on, vast improvements have occurred, the number of transplants has increased over time, and post-transplant survival curve has progressively improved.
Methods:
The purpose of this review is to analyze the current status of pediatric HT, including epidemiology of heart failure, number of ventricular assist devices, number of transplants, and outcomes. The pretransplant, contemporary issues of children with heart failure, the waiting list for transplant, the role of multidisciplinary team, perspectives to overcome the storage of donors with xenotransplantation, donation after circulatory death, and ABO-incompatible transplantation are discussed.
Results:
The outcome of transplantation in children and the main post-transplant issues related to immunosuppression, transition, and adherence were addressed, as well as the use of telemedicine as an additional tool for surveillance.
Conclusion:
HT in pediatric population is an established treatment for end-stage heart disease patients. The survival has increased over time, and there is a promising improvement in the care of these patients in relation to quality of life based on advances in the current researches and research and innovations in the future, improving life expectancy.
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