Pediatric heart transplantation: long-term outcomes

Abstract

Pediatric heart transplant has become the standard of care for end-stage heart disease in children throughout the world. The number of transplants has grown dramatically since the first transplant was performed, and over the last two decades, outcomes have consistently improved with progression in knowledge enhancing the clinical course and outcomes of these patients. Short-term outcomes in the most recent era have been excellent resulting in a renewed focus towards medium- and long-term outcomes. This article will review the most up-to-date literature on overall heart transplantation outcomes and specific long-term outcomes including rejection, cardiac allograft vasculopathy, graft failure, infection, renal dysfunction, malignancy, and the need for re-transplantation. The article also explores the post-transplantation outcomes of special populations, including Fontan patients, ABO-incompatible recipients, sensitized recipients, extracorporeal membrane oxygenation, and ventricular assist devices. The article concludes with a look at transition from pediatric to adult care and medication adherence, which are becoming major issues related to long-term outcomes as post-transplant survival increases.

Keywords: Outcomes; Pediatric; Transplant.

Fig. 1

Kaplan-Meier survival curve out to 25 years after pediatric heart transplantation stratified by age at the time of transplantation (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 2

Kaplan-Meier survival curve out to 25 years after pediatric heart transplantation stratified by era (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 3

Relative incidence of the leading causes of death for the most recent era January 2004 to June 2016 following pediatric heart transplant (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 4

Kaplan-Meier survival in pediatric heart transplant recipients based on the presence of rejection within the first year after transplantation (conditional on survival to 1 year) (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 5

Percentage experiencing treated rejection between discharge and 1-year follow-up by induction in pediatric heart transplant recipients (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 6

Freedom from severe renal dysfunction by age group in pediatric heart transplant recipients (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 7

Freedom from malignancy by type of malignancy in pediatric heart transplant recipients (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 8

Freedom from lymphoma by induction type in pediatric heart transplant recipients (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 9

Pediatric heart re-transplants by year of transplantation (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 10

Pediatric heart re-transplants by inter-transplant interval and recipient age (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 11

Kaplan-Meier survival by PRA in pediatric heart transplant patients with initial diagnosis of CHD (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)

Fig. 12

Kaplan-Meier survival by PRA in pediatric heart transplant patients with initial diagnosis of DCM (used with permission from the Registry of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2017;36:1037–79)