Journal of Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2433-1783 Print ISSN: 2433-2720
Japanese Society of Pediatric Cardiology and Cardiac Surgery
Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of Pediatric Cardiology and Cardiac Surgery 2(1): 1-19 (2018)
doi:10.24509/jpccs.180101

ReviewReview

Pediatric Heart Transplant in the United States: Current Status, Outcomes, and Ongoing Challenges

1Pediatric Cardiology, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children ◇ Wilmington, DE, USA

2Pediatric Cardiology, Nemours Children’s Hospital ◇ Orlando, FL, USA

3Cardiothoracic Surgery, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children ◇ Wilmington, DE, USA

発行日:2018年3月31日Published: March 31, 2018
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Heart transplant remains an important treatment option for end-stage heart failure in children who have failed maximum medical management. Although the outcome of heart transplant has significantly improved due to advances in perioperative management and immunosuppression, commonly, it is not a permanent solution. We still encounter multiple problems in managing these patients before and after transplant, not only with hemodynamic derangement, but also with functional deterioration of multiple organ systems. Shortage of donor hearts in association with wait-list mortality remains a major ongoing problem, especially for infants. Importantly, transplant for patients with congenital heart disease has unique challenges, including complexity of surgical reconstruction, coagulation abnormalities, allosensitization, and specific problems related to single ventricular palliation. Even after successful transplant, chronic complications emerge as inevitable challenges, including rejection, infection, allograft vasculopathy, lymphoproliferative disorders, and renal dysfunction. Here, we review the current status of pediatric heart transplant in the United States and discuss ongoing major problems frequently encountered with this special life-saving treatment modality. Underlying mechanisms of these complications are reviewed in conjunction with potential management strategies.

Key words: wait-list mortality; immunosuppression; rejection; cardiac allograft vasculopathy (CAV); post-transplant lymphoproliferative disorders (PTLD)

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