Heart Transplantation in Children

Overview

Heart transplantation represents the only effective method of treatment of intractable heart diseases. Cardiomyopathywith heart dilation, inoperable congenital heart diseases and heart failure after the heart surgery represent the mostcommon indications for heart transplantation in pediatrics. Hypoplastic left heart syndrome is the most frequentindication for the heart transplantation in neonates and infants. In infants steroids-free immunosuppression is usedor steroids are withdrawn 6 to 12 months after the transplantation. Graft failure, acute rejection and infection arethe most common causes of death after transplantation. Long-term results and the quality of life depend on theoccurrence of rejection, infection, graft vasculopathy, lymphoproliferative disease and side effects of immunosuppression.Posttransplant graft vasculopathy, however, represents the most dangerous late complication, which requiresretransplantation. Improvement of the transplantation program improves the survival rate as well as the quality oflife after transplantation. Survival after heart transplantation is 80 % in one year and 50 % in ten years interval.Better results can be achieved in neonates. Lack of donors, demanding economical and organisational conditionsand the unresolved legislation problems preclude wider use of heart transplantation in children. Research for moreeffective, safer and cheaper pharmacotherapy in the prevention and treatment of rejection, infection and complicationsof immunosupression is required. Long-term effects and the quality of life after heart transplantation in children, aswell as possibilities of mechanical heart support and xenotransplantation must be also studied.

Key words:
Heart transplantation, heart failure, congenital heart diseases, cardiomyopathy, immunosuppression,complications, child.