Cardiac Transplantation in Pediatrics: Drugs and Treatment

Heart transplantation is a standard treatment for some pediatric patients with end-stage cardiac disease. With advances in surgical technique, postoperative care, and immunosuppression, survival has increased significantly and, in most cases, can reach 15 to 20 years. The most common indication for heart transplantation in children is cardiomyopathy, followed by complex congenital heart diseases. An irreversible increase in pulmonary vascular resistance is an accepted contraindication to transplantation, although an accepted value for IRVP remains controversial. Graft survival depends on ongoing immunosuppression. It is also common for patients to take several other medications to treat or prevent transplant complications. Corticosteroids, such as prednisolone and methylprednisolone, cause a decrease in peripheral blood lymphocytes. Antiproliferative agents, such as mycophenolate mofetil (MMF) and azathioprine (AZA), inhibit purine metabolism, resulting in dysfunctional DNA synthesis in lymphocytes. Both can be administered orally or by intravenous infusion. Posttransplant hypertension is general and is partly due to the side effects of steroids and calcineurin inhibitors. Most patients require at least one antihypertensive agent. Cardiac allograft vasculopathy (CAV) has a major impact on the long-term prognosis of transplant patients. Current medical management of VAC is limited. The introduction of mammalian target of rapamycin inhibitors has shown promise in slowing disease progression.