Summary
In recent years, important developments in pediatric heart transplantation have taken place. Presently five-year survival varies between 50 and 70% in most centers. This is due to improved immunosuppressive regimens, better rejection monitoring and changes in infection treatment and prevention. Pediatric heart transplantation has outgrown its experimental status and has become a treatment option for a wider range of patients with congenital and acquired pediatric heart disease. Some centers even offer neonatal heart transplantation as a treatment for children with severe congenital heart disease. The most important drawback is the relative shortage of donor hearts leading to high mortality in patients on the waiting list. Hopefully the development of xenotransplantation with donor hearts from genetically manipulated animals will resolve this shortage.
Samenvatting
De laatste jaren zijn er belangrijke ontwikkelingen geweest op het gebied van de pediatrische ruilhartoperaties. De vijfjaarsoverleving schommelt in de verschillende centra tussen 50 en 70%. Nieuwe immunosuppressieschema's, betere rejectiemonitoring en infectiepreventie hebben deze gunstige overlevingscijfers mogelijk gemaakt. Deze gunstige resultaten hebben gezorgd voor verdere uitbreiding van de transplantatie-indicaties. Meer kinderen met congenitale hartafwijkingen komen op de transplantatiewachtlijst terecht. Ook neonatale transplantaties worden in een aantal centra uitgevoerd, met vergelijkbare resultaten. De lange termijnoverleving is momenteel nog onduidelijk. De belangrijkste rem op de ruimere indicatiestelling is het tekort aan donorharten, waarvoor op termijn enkel de ontwikkeling van genetisch gemanipuleerde dierenharten potentieel een oplossing kan bieden.
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Luc Mertens, Benedicte Eyskens, Marc Gewillig, Congenitale Cardiologie, Universitaire Ziekenhuizen Leuven, België.
Correspondent: Luc Mertens, Congenitale Cardiologie, Universitaire Ziekenhuizen Leuven, Herestraat 49, 3000 Leuven, België.
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Mertens, L., Eyskens, B. & Gewillig, M. Harttransplantatie bij kinderen, adolescenten en patiënten met congenitale hartvitia. KIND 68, 103–108 (2000). https://doi.org/10.1007/BF03061291
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DOI: https://doi.org/10.1007/BF03061291