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Emerging science in paediatric heart transplantation: donor allocation, biomarkers, and the quest for evidence-based medicine

Published online by Cambridge University Press:  17 September 2015

Kevin P. Daly
Kevin P. Daly*
Affiliation:
Department of Cardiology, Transplant Research Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
*
Correspondence to: Dr K. P. Daly, MD, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, United States of America. Tel: +617 355 6329; Fax: +617 734 9930; E-mail: [email protected]
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Abstract

Heart transplantation offers excellent survival benefit to children with end-stage heart failure. With its success, the number of potential recipients continues to exceed the number of available donors. Developing strategies to safely increase donor utilisation is crucial to decreasing wait-list mortality. A new paediatric heart allocation policy is set to be implemented with the goal of prioritising the most urgent listed candidates. Owing to excellent outcomes of ABO-incompatible heart transplantation, the sickest infants will soon receive priority for heart offers irrespective of blood group. Allosensitisation poses unique challenges within the paediatric population; ongoing multi-centre studies are poised to refine our understanding of key risk factors and optimal treatment strategies. Biomarkers for acute cellular rejection, such as donor-specific cell-free DNA, and cardiac allograft vasculopathy, such as VEGF-A, may lead to a decreased need for invasive screening. Ultimately, well-designed and executed randomised control trials of post-transplant immunosuppression are required to improve long-term outcomes after paediatric heart transplantation.

Keywords

Paediatric heart transplantationorgan allocation policyantibody-mediated rejectioncardiac allograft rejectiondiagnostic tests
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Supplement S2: Special Supplement of Cardiology in the Young: Proceedings of the 2015 International Paediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute , August 2015 , pp. 117 - 123
Copyright
© Cambridge University Press 2015 

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