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Heart transplantation in special patient populations

Kathryn R Armstrong1, Anne I Dipchand2

  • 1Heart Centre, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, Canada, V6H3N1.

JHLT Open
|October 28, 2025
PubMed

Insights

Heart transplantation (HTx) in special populations requires careful consideration of medical, developmental, and psychosocial factors. Evaluating these aspects ensures optimal outcomes and quality of life for children with genetic conditions, myopathies, and intellectual delays.

Area of Science:

  • Pediatric Cardiology
  • Transplant Surgery
  • Genetics

Background:

  • Heart transplantation (HTx) is increasingly considered for pediatric patients with end-stage heart failure.
  • Special patient populations, including those with genetic conditions, myopathies, mitochondrial disorders, connective tissue disorders (CTDs), and intellectual developmental delay, present unique challenges for HTx.
  • Determining the best interests of the child, encompassing medical, physical, emotional, developmental, and psychosocial aspects, is paramount.

Purpose of the Study:

  • To review the indications for HTx in special pediatric patient populations.
  • To explore outcomes and survival rates for these patients.
  • To highlight key considerations for evaluating suitability and optimizing post-transplant care.

Main Methods:

  • Literature review focusing on heart transplantation in pediatric patients with specific underlying conditions.
  • Analysis of existing data on outcomes, survival, and complications.
  • Discussion of multidisciplinary evaluation principles aligned with ISHLT guidelines.

Main Results:

  • HTx evaluation for these populations requires a comprehensive assessment of cardiopulmonary status, comorbidities, and psychosocial factors.
  • Specific conditions like mitochondrial disorders and Noonan syndrome may pose unique risks, including accelerated disease progression or increased post-transplant complications.
  • Further research is needed to fully understand long-term outcomes in these complex cases.

Conclusions:

  • A holistic, patient-centered approach is essential for heart transplantation in children with complex underlying conditions.
  • Careful pre-transplant evaluation and ongoing monitoring are crucial for maximizing survival and quality of life.
  • Addressing the specific risks associated with genetic conditions, myopathies, CTDs, and intellectual delays is vital for successful HTx outcomes.

Keywords:
Downs syndromeGenetic syndromeHeart transplantIntellectual disabilityMuscular dystrophyNoonan syndrome

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