Failing Cardiac Transplant

Cardiac transplantation is a life-saving procedure for children with heart failure unresponsive to medical management. Congenital heart disease remains the most common indication for recipients under 1 year of age. Dilated cardiomyopathy, the most common etiology for transplantation in the older child, is increasingly a reason for heart transplantation in patients <1 year of age. Complications of cardiac transplantation in the early postoperative period include acute rejection, anastomotic related issues with the transplanted heart, and postoperative infection. Chronic complications include rejection, infection, and cardiac allograft vasculopathy. Children with heart failure do not always appear ill despite compromised cardiac function, and this chapter aids in the perioperative assessment and management of a patient with a failing heart transplant.