Pediatric Heart Transplantation 2011

Pediatric heart transplantation is a well respected procedure for end-stage heart disease due to inoperable congenital heart defect or cardiomyopathy for almost 30 years. The results of the last decade show an increase in the 1-year survival to 70-90% depending on age at time of transplant. Most of the children attend kindergarten and school, and will learn a regular profession. Nevertheless some of them suffer from neurocognitive problems and an IQ at the lower end. The long-term outcome and quality of life is influenced by side effects of the immunosuppression. Leading problems are rejections, which take place most of the time in the first year after transplantation and at the worst can lead to graft failure. Due to the necessary immunosuppression there is an increase in infections like CMV and EBV. The last one is associated with posttransplant lymphoproliferative disease. After 12 years post transplantation 12% of children will suffer from this disease. Again, immunosuppression is the reason for chronic renal insufficiency which will rarely lead to dialysis and kidney transplantation. Finally graft coronary artery disease influences the long-term outcome, and is the main leading cause for mortality after 10 years of transplantation. In summary pediatric heart transplantation is a life-extending therapy with a good perspective in the future, significant morbidity can compromise the long-term outcome. Therefore a balanced decision has to be made in the best interest of the patient and the family.