THÔNG TIN TÀI LIỆU
Heart and Heart-Lung Transplantation Anne I Dipchand, Julie Schmidt, Richard Kirk Abstract Outcomes for heart transplantation for children have improved remarkably over the last 20 years due to improvements in donation and the preservation of organs, selection of patients, postoperative management, treatment of rejection, and management of comorbidities related to chronic immunosuppression The field has evolved further with the availability of mechanical support bridging options, though deaths while waiting remain high Pretransplant assessment is of utmost importance, as recipient factors significantly affect wait list time and posttransplant mortality rate There remain differences in outcome related to diagnosis and age, with patients with cardiomyopathy faring better and adolescents faring worse Rejection, infection, primary graft failure, and cardiac allograft vasculopathy remain the main causes of death Sensitization to HLA antibodies is being faced more frequently A comprehensive multidisciplinary team is essential to optimize outcomes before and after transplant by meticulous attention to detail Care for children after heart transplantation must account for physical growth and development; the stage of immune development; intellectual, social and emotional maturation; educational activities; and other parameters of quality of life The functional status of most patients is excellent, although there are challenges with development, school performance, and adherence Future opportunities include decreasing longterm morbidities related to immunosuppression, improving wait list mortality, and improving outcomes for the youngest patients and those with congenital heart disease Keywords Heart transplant; Heart failure; Rejection; Survival The first transplantation of a human heart was performed in South Africa in 1967.1 By the end of the 1970s, transplantation was established as an effective therapy for end-stage cardiac failure Over the next 30 years, improvements in donation and the preservation of organs, selection of patients, postoperative management, and treatment of rejection have resulted in markedly improved survival following transplantation in both adults and children Consequently, orthotopic transplantation of the heart is now the standard of care for the management for some infants and children with severe forms of congenital cardiac disease and end-stage cardiomyopathy More recently, the field has evolved further with the availability of mechanical support options as a bridge to decision and to transplantation, with a significant impact on both waiting and posttransplant survival
Ngày đăng: 22/10/2022, 12:43
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