Cardiac transplantation for hypoplastic left heart syndrome

Abstract

Cardiac transplantation is now a therapeutic option with good outcomes for infants and children with end-stage cardiac failure or inoperable congenital cardiac defects.1In 2000, 356 procedures in children aged up to 18 years were reported to the United Network for Organ Sharing – International Society of Heart and Lung Transplantation Registry.2Congenital cardiac disease was the most common indication in children less than 1 year of age, and overall was the most common diagnosis leading to cardiac transplantation in children. As a result of the groundbreaking contributions of Bailey et al.,3transplantation is now an option for primary treatment of infants with hypoplastic left heart syndrome born in the United States of America. The availability of donor organs, however, both limits the number of children with hypoplastic left heart syndrome who can be realistically offered transplantation, and contributes significantly to morbidity, mortality, and costs. Current limitations in the identification and availability of donors would not allow transplantation to be the primary option for all children born with hypoplastic left heart syndrome. Analyses of the database of the Registry, however, indicated that only about half of donations resulted in transplantation of the heart.4These observations provide compelling evidence of significant opportunities to improve rates of donation, and to utilize better the existing donations, with emphasis on optimizing identification of donors, expanding the number of potential donors, and better distribution of the available organs.