Cardiac Retransplantation for Graft Vasculopathy in Children

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Abstract
DURING THE past 15 years, cardiac transplantation (CTx) has been offered as therapy for a variety of inoperable cardiac conditions in infants and children. Worldwide, this therapy is now carried out in about 300 children a year with good (70%-80%) 3-year survival.1,2 As this population of children grows in size and enjoys a prolonged survival, diffuse, concentric graft atherosclerosis known as graft vasculopathy (GV) will develop in 10% to 35% of patients.3-5 This form of accelerated atherosclerosis has emerged as the leading cause of morbidity and mortality in long-term survivors of CTx. Cardiac retransplantation (re-Tx) is the only therapeutic option of proven benefit to children with primary GV. Recently, however, numerous ethical, moral, and fiscal concerns have been raised regarding the merits of cardiac re-Tx. Critics point to the cost of re-Tx and the shortage of suitable donor organs and, using data from the adult transplantation experience, argue that the outcomes of patients with cardiac re-Tx are inferior to those of patients with primary grafts.6,7