Pediatric cardiac transplantation: management issues.
Pediatric heart transplantation is an effective therapeutic modality for children with end-stage heart disease. The overall survival of young heart recipients is very good: 89% to 92% one year survival. Survival data for the long term indicates that pediatric heart recipients have a very good chance of living for decades. Advances in immunosuppression have lent optimism for the future. There are now alternatives in induction, maintenance, and acute rejection therapy. Immunosuppressants are more specific in action and prevent and treat allograft rejection with less toxic side effects and decreased morbidity. Acute rejection and infection are early complications that reduce in incidence significantly after six months post-transplant. Graft coronary artery disease continues to be the most significant hurdle to long-term survival. Currently there is a plateau in the number of heart transplants performed annually. Lack of available pediatric donors plays a large role in the paucity of pediatric transplants. This review focuses on the key management issues involved in the care of the pediatric heart transplant recipient and incorporates the experiences and protocols of the Stanford University Pediatric Heart Transplant Program.
Luikart
H
H
Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
D001706:Biopsy; D005544:Forecasting; D006084:Graft Rejection / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000451:nursing* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D017053:Infection Control / Q000379:methods; D009017:Morbidity; D018579:Patient Selection; D010371:Pediatric Nursing / Q000379:methods* / Q000639:trends; D019990:Perioperative Care / Q000379:methods* / Q000451:nursing*; D012720:Severity of Illness Index; D016019:Survival Analysis