Pediatric Heart Transplantation

Pediatric heart transplantation has grown tremendously since the first pediatric orthotopic heart transplant in 1967 and is performed routinely in over one hundred centers worldwide. Heart transplantation is now the standard of care for children with end-stage heart disease. Post-transplant survival continues to improve with the current median survival among all pediatric recipients now over 18 years. Achievement of normal childhood functional status is expected post-transplantation. Thoughtful patient selection for heart transplant listing is one of the most important factors influencing post-transplant outcomes and is crucial for optimal allocation of a scarce resource. In this chapter, we will review the indications and contraindications for heart transplantation, discuss transplantation in the era of ventricular assist devices, review waitlist management and donor selection, and discuss patient evaluation for heart transplant candidacy.