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<p>Despite major advances in the treatment of pediatric cardiology patients, heart transplantation (HTx) remains the only therapeutic option for children with end-stage heart failure. Beyond therapy-refractory heart failure, malignant arrhythmias and emerging pulmonary hypertension can also serve as indications for heart transplantation. Before listing, a comprehensive evaluation of heart transplant candidates is essential. The sensitization with HLA antibodies represents a&#xa0;particular challenge. In infancy an AB0-incompatible transplantation is possible and is nowadays&#xa0;clinical routine.</p><p>Children listed for heart transplantation have the highest waitlist mortality among pediatric solid organ transplantat candidates. The use of mechanical circulatory support, particularly ventricular support systems has greatly improved waitlist survival. Early complications after transplantation includes primary graft failure, hemorrhages and right heart failure, respectively. Following transplantation, individualized immunosuppressive therapy is of central importance to prevent allograft rejection and long-term complications. Close monitoring of rejection is crucial, particularly in the first year post-transplant. Cardiac allograft vasculopathy (CAV) represents the primary cause of long-term graft failure. Data from international registries show that children younger than one year at the time of transplantation have the best long-term survival (median 22.3 years), whereas adolescents exhibit the least favorable prognosis. Despite a decreasing era-effect, progress in the diagnostics, perioperative management and immunotherapy have greatly improved the prognosis of pediatric HTx patients in the past decades.</p>

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Herztransplantation im Kindesalter

  • 期刊论文

  • 发表日期：

    2025年11月28日

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  • Lisa-Maria Rosenthal,
  • Annemarie Krauß,
  • Friederike Danne

摘要

Despite major advances in the treatment of pediatric cardiology patients, heart transplantation (HTx) remains the only therapeutic option for children with end-stage heart failure. Beyond therapy-refractory heart failure, malignant arrhythmias and emerging pulmonary hypertension can also serve as indications for heart transplantation. Before listing, a comprehensive evaluation of heart transplant candidates is essential. The sensitization with HLA antibodies represents a particular challenge. In infancy an AB0-incompatible transplantation is possible and is nowadays clinical routine.

Children listed for heart transplantation have the highest waitlist mortality among pediatric solid organ transplantat candidates. The use of mechanical circulatory support, particularly ventricular support systems has greatly improved waitlist survival. Early complications after transplantation includes primary graft failure, hemorrhages and right heart failure, respectively. Following transplantation, individualized immunosuppressive therapy is of central importance to prevent allograft rejection and long-term complications. Close monitoring of rejection is crucial, particularly in the first year post-transplant. Cardiac allograft vasculopathy (CAV) represents the primary cause of long-term graft failure. Data from international registries show that children younger than one year at the time of transplantation have the best long-term survival (median 22.3 years), whereas adolescents exhibit the least favorable prognosis. Despite a decreasing era-effect, progress in the diagnostics, perioperative management and immunotherapy have greatly improved the prognosis of pediatric HTx patients in the past decades.