日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Survival after pediatric heart transplantation has been improving ever since the procedure was first performed. The international survival data showed that the actual 5-year survival rate was approximately 70％. This improvement was observed mostly in the period immediately following heart transplantation, but intermediate and late mortality have not improved. Therefore, how to manage pediatric recipients in the long term after heart transplantation is important issue. Not only management of immunosuppressive therapy and rejection but also detection and treatment of major post-transplant complications, including infection, coronary allograft vasculopathy, renal dysfunction and malignancy are essential. In addition, other important issues are to assess somatic growth and intellectual and psychosocial development in children after heart transplantation. Transitional care, including management of nonadherence in adolescents after transplantation, is also important. Total post-transplantation care by a multidisciplinary team may improve long-term outcome after pediatric heart transplantation.