Search

Renal complications are common following heart and/or lung transplantation and lead to increased morbidity and mortality. Renal dysfunction is also associated with increased mortality for patients on the transplant wait list. Dialysis dependence is a relative contraindication for heart or lung transplantation at most centers, and such patients are often listed for a simultaneous kidney transplant. Several factors contribute to the impaired renal function in patients undergoing heart and/or lung transplantation, including the interplay between cardiopulmonary and renal hemodynamics, complex perioperative issues, and exposure to nephrotoxic medications, mainly calcineurin inhibitors., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Lung transplantation, heart transplantation, and heart-lung transplantation are life-saving treatment options for patients with lung and/or cardiac failure. Evolution in these therapies over the past several decades has led to better outcomes with application to more patients. The complexity and severity of illness of patients in the pretransplant phase has steadily increased, making posttransplant intensive care unit management more difficult. Despite these factors and the pervasive complications of immunosuppressive therapy, outcomes continue to improve., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Cardiac transplantation remains a life-prolonging process. Survival after heart transplantation has improved despite a sicker incoming patient population. The field of heart transplantation is constantly evolving. Advances in organ preservation, immune monitoring, and improved immunosuppressive regimens will continue to develop over time. The impact of the newest immunosuppressive agents and protocols, improved diagnostic testing, and new management strategies is yet to be determined. The potential of cell therapy is still under evaluation and the field is still in its infancy but rapidly evolving; the key to the future in this field may not be the delivery of the cells themselves but understanding how they interact with one another at a molecular level and, in particular, with resident stem cells in cardiac tissue. In addition to the medical advances, health care professionals need to educate the public about the benefits of transplantation as well.

Heart transplantation is now an accepted method for treatment of heart disease in children, but transplantation in pediatric recipients continues to present unique challenges. The differences in indications and the complexity of surgery for congenital heart disease are only two of those challenges. A successful means of mechanical support is not available, which puts children at special risk of dying while waiting for transplantation. In addition, physiologic differences produce issues about management after transplantation, including use of immunosuppressive agents, control of infection, identification of transplant coronary artery disease, and posttransplant lymphoproliferative disease. Because of the longer life expectancy desired from pediatric transplantation, measurement of quality of life must be more comprehensive. This broad range of special demands means that although the state of pediatric heart transplantation is positive, there are areas for continued improvement.

Outcomes in cardiac transplantation have improved during the past 30 years because of advances made in medicine and surgery. Patients referred for cardiac transplantation are examined through a rigorous evaluation process that involves a multidisciplinary approach to determine candidacy. The list for candidates awaiting transplantation has grown more rapidly than the donor pool, resulting in a need to expand the criteria for donors. Some centers now extend criteria to include older donors, those with prolonged periods of ischemia, donor-recipient mismatches, and donors requiring bypass surgery. Long-term outcomes from the expanded donor pool are under evaluation. Studies are currently in progress to explore inducing tolerance through bone marrow infusion and rejection detection with the use of a pacemaker. Future alternatives to transplantation include the left ventricular assist device as a bridge to recovery, xenotransplantation, and the totally artificial heart.