Organ Transplantation: Pediatric heart transplantation

Pediatric heart transplantation dates back to December 1967, with Kantrowitz’s unsuccessful attempt at infant heart transplantation. Sixteen years later, Bailey ushered in the era of clinical infant heart transplantation after a failed xenotransplant attempt. Today, more than 700 pediatric heart transplants are performed annually, with average survival exceeding 90% at 1 year and, among infants, a median survival of more than 20 years. Major causes of death include graft failure, allograft vasculopathy, rejection, infection, and malignancy. With current preservation techniques, the incidence of early graft failure has been reduced to about 2%. About 40% of patients experience one or more rejection episodes in the first year. Antibody mediated rejection is much less common but when associated with hemodynamic compromise 50% of patients die within 5 years. Infection incidence is time-related, with bacterial infections most prevalent in the first 2 months. Post-transplant lymphoproliferative disease is caused by Epstein-Barr virus in over 80% of cases, and the greatest risk is between 6 and 12 months. Allograft vasculopathy, a manifestation of chronic rejection, affects 15% of patients by 5 years and 30% by 10 years. Allograft vasculopathy is the most common indication for retransplantation with expected graft survival only slightly worse than with the original graft.