J.Jpn. Surg. Soc.. 111(5): 279-283, 2010

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Feature topic

CURRENT OUTCOMES AND FUTURE PERSPECTIVES OF PEDIATRIC HEART TRANSPLANTATION

Pediatric heart transplantation involves many challenges not frequently encountered in the adult population. Several unique issues include the large variation in cardiac configuration in congenital heart disease, limited availability of mechanical circulatory assist devices, immature immune responses, and consideration of somatic growth. Nevertheless, significant improvement in survival outcomes has been achieved in the last two decades, mainly from the decreased mortality early after transplantation. A severe shortage of donor hearts is the most serious problem, especially in infants who cannot be supported by assist devices. The use of ABO-incompatible or after-cardiac-death donors is under investigation to maximize the available organ pool. Long-term survival is still limited mainly by graft coronary artery vasculopathy, although its incidence is less than in the adult population. Further efforts are required to increase available donors, overcome graft coronary artery vasculopathy, and improve pretransplantation management including the development of pediatric mechanical circulatory support devices.

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