Pediatric heart transplantation: immunosuppression and its complications.
OBJECTIVE
Advances in immunosuppression have contributed to the significant improvements in outcome for pediatric heart transplant recipients in the past two decades. The large increase in the number of available immunosuppressive agents in the past few years mandates that those caring for this complex group of patients remain up to date in this rapidly advancing field.


RESULTS
In this review, we evaluate recent studies of immunosuppressive efficacy, end-organ toxicities, and side effects of nonspecific immunosuppression with currently used regimens. In addition, we examine new findings that attempt to define the genetic contribution to rejection profiles, immunosuppressive efficacy, and drug disposition after heart transplantation in children.


CONCLUSIONS
The continuous evaluation of new immunosuppressive regimens will help to elucidate the optimal treatment regimens for pediatric heart transplant recipients. Unfortunately, the small number of transplantations means that it is unlikely that pivotal randomized, controlled trials will ever be performed in this population. Extrapolation from adult controlled trials and experience from other pediatric solid organ transplant recipient populations will continue to provide important contributions to our knowledge base. Understanding the genetic contribution to graft and patient outcomes may help us tailor immunosuppressive therapy for the individual patient.
Russo
Linda M
LM
Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Webber
Steven A
SA
D000328:Adult; D002648:Child; D016207:Cytokines / Q000096:biosynthesis / Q000235:genetics; D018432:Drug Resistance, Multiple / Q000235:genetics; D019450:Genes, MDR; D006084:Graft Rejection / Q000235:genetics / Q000276:immunology; D006331:Heart Diseases / Q000628:therapy*; D016027:Heart Transplantation / Q000276:immunology* / Q000379:methods; D006801:Humans; D007108:Immune Tolerance / Q000235:genetics; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015182:Lymphatic Irradiation / Q000009:adverse effects; D011110:Polymorphism, Genetic / Q000276:immunology*; D016896:Treatment Outcome
D016207:Cytokines; D007166:Immunosuppressive Agents