Pediatric heart transplantation: long-term outcomes
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REVIEW ARTICLE
Pediatric heart transplantation: long-term outcomes Anne I. Dipchand 1 & Jessica A. Laks 1 Received: 17 October 2018 / Revised: 15 March 2019 / Accepted: 19 March 2019 # Indian Association of Cardiovascular-Thoracic Surgeons 2019
Abstract Pediatric heart transplant has become the standard of care for end-stage heart disease in children throughout the world. The number of transplants has grown dramatically since the first transplant was performed, and over the last two decades, outcomes have consistently improved with progression in knowledge enhancing the clinical course and outcomes of these patients. Shortterm outcomes in the most recent era have been excellent resulting in a renewed focus towards medium- and long-term outcomes. This article will review the most up-to-date literature on overall heart transplantation outcomes and specific long-term outcomes including rejection, cardiac allograft vasculopathy, graft failure, infection, renal dysfunction, malignancy, and the need for retransplantation. The article also explores the post-transplantation outcomes of special populations, including Fontan patients, ABO-incompatible recipients, sensitized recipients, extracorporeal membrane oxygenation, and ventricular assist devices. The article concludes with a look at transition from pediatric to adult care and medication adherence, which are becoming major issues related to long-term outcomes as post-transplant survival increases. Keywords Pediatric . Transplant . Outcomes
Introduction Pediatric heart transplant has become the standard of care for end-stage heart disease in children throughout the world. The number of transplants has grown dramatically since the first transplant was performed in 1967 with the annual number of transplants reported to the International Society of Heart and Lung Transplantation Registry increasing from 414 reported in 2000 to 684 reported in 2015, with almost 14,000 transplants in children reported in total. [1] Over the last two decades, outcomes have consistently improved with progression in knowledge enhancing the clinical course and outcomes of these patients. Short-term outcomes in the most recent era have been excellent resulting in a renewed focus towards medium- and long-term outcomes. Rejection, cardiac allograft vasculopathy (CAV), graft failure, and infection continue to be the major causes of death within the first 5 years post-transplant. [2] As well, renal dysfunction, malignancy, and the need for re-transplantation remain as significant issues that require
* Anne I. Dipchand [email protected] 1
Cardiology and Transplant, Institution: Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
close follow-up. This article will review the most up-to-date literature on overall heart transplantation outcomes, as well as take a closer look at specific long-term outcomes, and explore the post-transplantation outcomes of special populations, including Fontan patients, ABO-incompatible recipients, sensitized recipients, extrac
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