Paediatric heart transplantation

Paediatric heart transplantation is the last remaining treatment option for children in end-stage heart failure. Approximately 30 heart transplants are performed in the UK each year, between two specialist centres. Approximately two-thirds of recipients have suffered from a cardiomyopathy (mainly dilated), with the remainder mainly being born with congenital heart disease that is, or has become unamenable to conventional surgery. Over the course of the last 20 years, improvements in surgical expertise, intensive care techniques and immunosuppressive strategies have vastly improved the outlook for these children, and it is predicted that the majority of grafts implanted today will last at least for 15 years. This inevitably means that patients transplanted as young children will require retransplant during adolescence or early adulthood, and with organ donation in the UK currently at severely low levels, the current chances of a second transplant are poor. The goals of transplant programmes must therefore be to postpone transplantation as long as possible and careful management of the post-transplant phase, in order to improve the longevity of donated organs. This article reviews the current practice of paediatric heart transplantation in the UK.