Pediatric Heart Transplantation: A Progress Report

Following the first orthotopic heart transplant performed in 1967, pediatric heart transplantation procedures, have undergone significant advances over the last five decades. Subsequently, survival times have improved over the years, whereby those receiving an orthotopic heart transplant now survive for decades longer. A significant advancement in this area involves the management of blood type (ABO) incompatibility. Recent protocols and antibody-mediated therapies have made ABO-incompatible transplants more feasible, improving graft survival. Real-time evaluation and optimization of donor hearts have also been revolutionized by expanding donor sources through donation after circulatory death. Innovation in management and preservation techniques has demonstrated that donations after circulatory death have acceptable post-transplant outcomes. Immunosuppressive therapy has also evolved with the emergence of tacrolimus monotherapy, which is gaining attention as a potential strategy for reducing the risks associated with polypharmacy while maintaining graft function. Moreover, ex-vivo perfusion systems have optimized donor heart preservation by reducing cold ischemia time and improving graft quality. With advancements in systems and processes, surgical procedures for partial heart transplantation have shown promise for selected patients. Ultimately, xenotransplantation is an emerging frontier in addressing the persistent organ shortage. Thus, this manuscript presents a comprehensive review of the progress in pediatric heart transplantation over the past decade, as well as the prospects for this field of research.