Journal of Pediatric Cardiology and Cardiac Surgery

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.