The Current Status of Paediatric Cardiac Transplantation

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Citation
Asia Pacific Cardiology - Volume 2 Issue 1;2008:2(1):74-78

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In the past 25 years, cardiac transplantation has become the standard of care for children with end-stage cardiomyopathy and congenital heart disease. Advances in medical therapy and peri-operative management have resulted in excellent medium-term survival rates.
Paediatric registry data from the International Society for Heart and Lung Transplantation (ISHLT) indicate that between 1982 and 2005 almost 7,000 heart transplants were undertaken. The current figure is approximately 400 transplants per year, distributed among 82 centres. Almost 45% of transplantations now occur at a centre performing an average of more than 10 each year.
This report discusses the current status of cardiac transplantation in children.

Indications

Typical indications for heart transplantation in children include the following:
• intractable symptomatic heart failure (New York Heart Association (NYHA) Class III-IV); • need for permanent mechanical cardiac support; • frequent repeated discharges from an implanted automatic implantable cardioverter defibrillator device; and • poor quality of life in patients with uncorrectable cyanotic heart disease.
Usual exclusion criteria include the following:
• active malignancy; • irreversible dysfunction of other organs (combined organ transplant may be a consideration [e.g. heart and lung or heart and kidney]); • irreversible degeneration/damage of other organ systems that precludes rehabilitation after heart transplantation; • uncontrolled infection; • inability to comply with complex medical therapy, e.g. due to chronic cognitive or neuropsychiatric deficits in the absence of a carer taking on this role; and • active substance abuse, including smoking, alcohol and illicit drug use.

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