Dipchand Anne I, Laks Jessica A
Cardiology and Transplant, Institution: Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada.
Indian J Thorac Cardiovasc Surg. 2020 Aug;36(Suppl 2):175-189. doi: 10.1007/s12055-019-00820-3. Epub 2019 May 29.
Pediatric heart transplant has become the standard of care for end-stage heart disease in children throughout the world. The number of transplants has grown dramatically since the first transplant was performed, and over the last two decades, outcomes have consistently improved with progression in knowledge enhancing the clinical course and outcomes of these patients. Short-term outcomes in the most recent era have been excellent resulting in a renewed focus towards medium- and long-term outcomes. This article will review the most up-to-date literature on overall heart transplantation outcomes and specific long-term outcomes including rejection, cardiac allograft vasculopathy, graft failure, infection, renal dysfunction, malignancy, and the need for re-transplantation. The article also explores the post-transplantation outcomes of special populations, including Fontan patients, ABO-incompatible recipients, sensitized recipients, extracorporeal membrane oxygenation, and ventricular assist devices. The article concludes with a look at transition from pediatric to adult care and medication adherence, which are becoming major issues related to long-term outcomes as post-transplant survival increases.
小儿心脏移植已成为全球范围内小儿终末期心脏病的标准治疗方法。自首次进行心脏移植以来，移植数量急剧增长，在过去二十年中，随着知识的进步改善了这些患者的临床病程和预后，预后持续改善。最近时期的短期预后非常好，这使得人们重新关注中长期预后。本文将综述有关心脏移植总体预后以及特定长期预后的最新文献，这些长期预后包括排斥反应、心脏移植血管病变、移植物衰竭、感染、肾功能不全、恶性肿瘤以及再次移植的需求。本文还探讨了特殊人群的移植后预后，包括接受Fontan手术的患者、ABO血型不相容的受者、致敏受者、体外膜肺氧合以及心室辅助装置。文章最后探讨了从小儿护理向成人护理的过渡以及药物依从性，随着移植后生存率的提高，这些正成为与长期预后相关的主要问题。
