Heart Transplantation

Abstract

Cardiac transplantation offers the only hope for survival and improved quality of life for selected children with end-stage heart disease, whether due to cardiomyopathy or congenital defects. The first pediatric transplant was performed by Kantrowitz and associates in December, 1967, only a few days after Dr. Christian Barnard’s pioneering operation in an adult. Interest in transplantation of the heart declined throughout the 1970s, due to the high mortality resulting primarily from lack of effective immunosuppressive medications. A resurgence of clinical activity developed in the early 1980s with the introduction of cyclosporine, the first oral immunosuppressive agent with relative specificity for inhibition of T-lymphocytes, the primary mediators of allograft rejection. This resulted in dramatic improvements in survival of all transplanted organs. Progress in the field of pediatric heart transplantation has been recently summarized [1]. With improvements in candidate and donor selection, preoperative management, surgical technique and early postoperative care, approximately 95% of heart transplant recipients should leave hospital alive and in good health after transplantation. Furthermore, pre-transplantation mortality has fallen. Thus, survival at all times after listing has also improved. This section will give an overview of the current state-of-the-art of pediatric heart transplantation, focusing on issues of key interest to those who work in the intensive care unit.