Heart transplantation in special patient populations

In this review of heart transplantation (HTx) in special patient populations, the indications for HTx for patients with underlying genetic conditions, myopathies, mitochondrial conditions, connective tissue disorders (CTDs), and intellectual developmental delay will be explored along with the outcomes and survival. A key principle for cardiologists looking after these patients who may develop end-stage heart failure and require HTx evaluation is to determine what is in the child's best interest from a medical, physical, emotional, developmental, and psychosocial perspective with a goal of providing the child not only survival but an acceptable quality of life within their underlying circumstances. This review highlights that much like clinicians do for any pediatric patient put forward for HTx and as the International Society of Heart Lung Transplantation (ISHLT) endorses an evaluation of the patient's cardiopulmonary status, comorbidities and psychosocial factors that may affect graft/patient survival should be considered for patients with underlying genetic conditions, myopathies, CTDs, and intellectual delays prior to transplantation. More research is required to better understand the risk and long-term outcomes of HTx in those with underlying mitochondrial conditions where HTx has accelerated the progression of disease in other organ systems and in conditions such as Noonan's syndrome, where patients have a higher risk of developing post-transplant complications such as post-transplant lymphoproliferative disorder.