Heart transplantation can be performed in both neonates and children with a low operative mortality and excellent long-term survival. Currently this is the only therapy available for children with end-stage cardiomyopathy and structural heart disease not amenable to conventional surgical therapy. For neonates with HLHS, the results of transplant are still being compared to the results of staged reconstruction. Improving results with staged reconstruction and poor availability of donors for infants have swung this pendulum toward staged reconstruction. We have transplanted only 1 baby with HLHS in the past 5 years. In older children, proper recipient selection, particularly with regard to pulmonary vascular resistance and its response to vasodilators, may decrease perioperative mortality. Challenges still remaining include improved immunosuppression, graft CAD, PTLD, and donor shortages. Out on the horizon are the use of xenografts, permanent chimerism/tolerance, genetic modulation of the donor, and permanent mechanical support.


1. Fricker RJ, Griffith BP, Hardesty RL et al. Experience with heart transplantation in children. Pediatrics 1987; 79:138-46.

2. Starnes VA, Bernstein D, Oyer PE et al. Heart transplantation in children. J Heart Transplant 1989; 8:20-6.

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