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LITERATURE REVIEW
Year : 2013  |  Volume : 7  |  Issue : 3  |  Page : 78-87

The current state and key issues of pediatric heart transplantation


Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada

Correspondence Address:
Anne I Dipchand
The Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.ijt.2013.05.001

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Pediatric heart transplantation has now been established as standard of care for infants and children with end-stage heart disease. Initial experience with transplantation of the heart in children was met with high mortality owing primarily to the lack of effective immunosuppressive medications. However, interest in pediatric heart transplantation had its resurgence in the late 1970s and early 1980s with the discovery and introduction of cyclosporine-based immunosuppression regimens. Outcomes have consistently improved with improved selection of candidates and donors, enhanced preservation of the donor heart, refinements in surgical technique, the development of endomyocardial biopsy for surveillance of rejection, and the histopathologic standardization of rejection. The last 10 years have shown exponential growth in knowledge affecting the clinical course and outcomes of these patients, contributing to the length of patient survival and improved quality of life. Significant limitations still exist including the need for lifelong immunosuppressive medications and toxicities associated with these drugs, the development of post-transplant lymphoproliferative disease, and chronic rejection or allograft vasculopathy. In this review, we will summarize some of the many lessons learned over the last 10 years, highlight recent advances in our knowledge, and describe some of the key issues and future trends of pediatric heart transplantation.


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