Unique Challenges in Paediatric Heart Transplantation.

Heart transplantation is the standard of care for children with end-stage heart disease refractory to medical and surgical interventions. It is performed across the age spectrum, from neonates to adolescents. Children awaiting transplant represent a critically ill group with high waitlist mortality, and an increasing percentage of children await transplant on ventricular assist device support. Post-transplant survival has improved significantly over the past three decades, but ongoing challenges exist to maximize long-term graft function, patient longevity, and quality of life. This review highlights some key challenges in the field of paediatric heart transplantation, including a discussion of unique features at both ends of the age continuum (infants and adolescents), ABO-incompatible transplant, limitations in rejection surveillance, the importance of long-term psychosocial support, patients with single ventricle physiology, genetic diagnoses, consideration of age and size in donor selection, live vaccination, and partial heart transplantation.