Post Cardiac Transplant Care for the General Pediatrician

Post heart transplant first year survival rate has improved to 92.1% (Singh TP, Hsich E, Cherikh WS, et al. in J Heart Lung Transplant, 2025). As a result, an increasing number of children are living into adolescence and adulthood with a transplanted heart. This review summarizes key aspects of pediatric heart transplant care, including immunization strategies, immunosuppressive regimens, and the management of transplant-related complications such as graft rejection, coronary allograft vasculopathy, post-transplant lymphoproliferative disorder, and infections, with particular emphasis on the evolving role of pediatricians in coordinating multidisciplinary management across the lifespan. Noninvasive rejection surveillance tools —such as donor-derived cell-free DNA and molecular diagnostics—are increasingly supplementing or replacing routine endomyocardial biopsy. Advances in immunosuppressive strategies including calcineurin inhibitor-sparing approach with mTOR inhibitors, has resulted in treatment-related morbidity. Growing recognition of psychosocial distress, impaired exercise capacity and reproductive health concerns has underscored the importance of integrated mental health services, structured transition planning, and family-centered care models. Pediatric heart transplantation has transitioned from a life-saving intervention with limited survival to a chronic condition requiring lifelong, comprehensive management. Pediatricians play a critical role in monitoring immunosuppression, preventing and identifying complications, supporting physical and neurodevelopmental health, addressing mental health and adherence, and providing anticipatory guidance on reproduction and family risk. Ongoing collaboration between primary care providers and transplant teams is essential to optimize long-term outcomes, enhance quality of life, and support the growing population of pediatric heart transplant survivors.