Heart Transplantation: Treatment for children and adolescents with end-stage heart disease.

Heart transplantation, which is the recently accepted treatment for children and adolescents with end stage heart disease, is the subject of this review article. Issues such as selection of patients, follow up and management post transplant are discussed, as well as the surgical procedure and the immediate postoperative management. Results from recent studies of long term survival following pediatric heart transplantation are discussed. Short term survival following heart transplantation is now excellent but limited long term follow-up data is available as this operation has only been performed for about two decades. One year survival is now over 90% and five year survival is estimated to be close to 70% in major transplant centers around the world. Post transplant coronary artery disease is mainly responsible for the decreased long term survival. Complications of immunosuppression such as infections, lymphoprolifrative disorders and depressed renal function are still common but usually not life threatening. Non-compliance with medication was observed amongst teenage recipients and can have lethal consequences. Despite this, it has been shown that heart transplantation can provide good quality of life and prolong survival in pediatric patients with end-stage heart disease.