[I-AEPCJS-01] Outcome of Paediatric Heart Transplantation
Heart transplantation is a standard treatment for selected paediatric patients with end stage heart disease. With improvement in surgical techniques, organ procurement and preservation strategies, immunosuppressive drugs, and more sophisticated monitoring strategies survival following transplantation has increased over time. However, rejection, infection, renal failure, post-transplant lymphoproliferative disease and post-transplant cardiac allograft vasculopathy still preclude long term survival. Therefore, continued multidisciplinary scientific efforts are needed for future gains.
The Registry of the International Society of Heart and Lung Transplantation shows a continued improvement in median survival in its most recent analysis of > 22 years for those <1 year of age, nearly 20 years for 1 to 5 years, around 15 years for 6 to 10 years and around 13 years for 11-17 years group. Whilst encouraging, these statistics highlight the relative reduction in post-transplant longevity in teenagers.
Paediatric heart transplant candidates have the highest waiting list mortality rate compared to other
solid organs. Improving survival depends on recipient factors, donor availability, and centres’
experience. Knowledge of death-related risk factors while waiting for an organ and post transplant
contributes to decision-making regarding transplant candidacy and timing of listing.
Patients with risk factors have significantly reduced post transplant survival, which worsens with increasing number of risk factors. Modifiable risk factors (MRF): include mechanical ventilation, renal dysfunction, liver dysfunction, infection, and poor nutrition status. Recipient factors outweigh donor factors in influencing short- and long-term outcomes. Therefore, a good transplant outcome starts from a comprehensive recipient evaluation in order to identify the patients with the greatest need and highest potential for favourable outcome post transplantation. All efforts should be made to optimise a potential transplant recipient status.
Efforts have been made to develop risk scores to assess candidacy and aid the listing process but this remains largely applicable to the adult population with non-congenital heart disease.
Having a predicting score model can be a useful tool to guide decision making process with a goal not only improving the survival but reducing the number of futile transplants, a major goal of contemporary organ allocation policy.
The Registry of the International Society of Heart and Lung Transplantation shows a continued improvement in median survival in its most recent analysis of > 22 years for those <1 year of age, nearly 20 years for 1 to 5 years, around 15 years for 6 to 10 years and around 13 years for 11-17 years group. Whilst encouraging, these statistics highlight the relative reduction in post-transplant longevity in teenagers.
Paediatric heart transplant candidates have the highest waiting list mortality rate compared to other
solid organs. Improving survival depends on recipient factors, donor availability, and centres’
experience. Knowledge of death-related risk factors while waiting for an organ and post transplant
contributes to decision-making regarding transplant candidacy and timing of listing.
Patients with risk factors have significantly reduced post transplant survival, which worsens with increasing number of risk factors. Modifiable risk factors (MRF): include mechanical ventilation, renal dysfunction, liver dysfunction, infection, and poor nutrition status. Recipient factors outweigh donor factors in influencing short- and long-term outcomes. Therefore, a good transplant outcome starts from a comprehensive recipient evaluation in order to identify the patients with the greatest need and highest potential for favourable outcome post transplantation. All efforts should be made to optimise a potential transplant recipient status.
Efforts have been made to develop risk scores to assess candidacy and aid the listing process but this remains largely applicable to the adult population with non-congenital heart disease.
Having a predicting score model can be a useful tool to guide decision making process with a goal not only improving the survival but reducing the number of futile transplants, a major goal of contemporary organ allocation policy.