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Purpose of Review <p>Pediatric heart transplantation remains the definitive therapy for children with end-stage heart failure and irreparable congenital heart disease, but remains limited by donor scarcity, lifelong immunosuppression, and non-growing valve replacement options. This review examines emerging strategies that may address these barriers.</p> Recent Findings <p>Advances in immune tolerance, including thymus-heart co-transplantation, may reduce or eliminate the need for chronic immunosuppression. Partial heart transplantation introduces living valve tissue capable of somatic growth, addressing a major limitation of existing prosthetic and bioprosthetic valves. Donation after circulatory death, normothermic regional perfusion, and on-table reanimation are expanding access to transplantable organs. Xenotransplantation and genetically engineered donor organs may further overcome donor availability constraints.</p> Summary <p>These innovations suggest a transition toward a pediatric heart transplantation paradigm centered on biological integration, organ stewardship, and precision immunology. Further research is needed to define durability, immunologic consequences, feasibility, and long-term outcomes.</p>

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Pushing the Frontier in Pediatric Heart Transplantation: Innovation Across Immunology, Organ Utilization, and Bioengineering

  • 期刊论文

  • 发表日期：

    2026年7月17日

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  • Seth E. M. Wolf,
  • Rebekah R. Boyd,
  • Neel K. Prabhu,
  • John A. Kucera,
  • Lindsey M. Reynolds,
  • Danielle R. Pitchon,
  • Akosua D. Odei,
  • Mir F. Bhora,
  • Douglas M. Overbey,
  • Joseph W. Turek

摘要

Purpose of Review

Pediatric heart transplantation remains the definitive therapy for children with end-stage heart failure and irreparable congenital heart disease, but remains limited by donor scarcity, lifelong immunosuppression, and non-growing valve replacement options. This review examines emerging strategies that may address these barriers.

Recent Findings

Advances in immune tolerance, including thymus-heart co-transplantation, may reduce or eliminate the need for chronic immunosuppression. Partial heart transplantation introduces living valve tissue capable of somatic growth, addressing a major limitation of existing prosthetic and bioprosthetic valves. Donation after circulatory death, normothermic regional perfusion, and on-table reanimation are expanding access to transplantable organs. Xenotransplantation and genetically engineered donor organs may further overcome donor availability constraints.

Summary

These innovations suggest a transition toward a pediatric heart transplantation paradigm centered on biological integration, organ stewardship, and precision immunology. Further research is needed to define durability, immunologic consequences, feasibility, and long-term outcomes.