Pediatric heart transplantation.

Since the introduction of cyclosporine in the early 1980s, there has been a surge of activity in the field of pediatric heart transplantation. Careful patient selection has resulted in operative and short-term patient survival comparable to that achieved in adult transplant programs. The results of neonatal heart transplantation have been exciting and encouraging; neonates may require less immunosuppressive therapy than older infants and children. Transplantation clearly offers the chance of survival and significant rehabilitation to children with end-stage heart disease. Long-term management issues include the effects of chronic immunosuppressive therapy on growth and development and renal function, and the time-related risk of rejection, infectious complications, neoplasms, and graft atherosclerosis.