Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors

Pediatric heart transplantation (HT) has transformed outcomes for children with end-stage heart failure. Despite advances in surgical techniques and immunosuppressive strategies, mortality remains influenced by numerous risk factors. This review consolidates current literature on pre- and post-trans...

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Main Authors: Sydney Elizer, MD, Benjamin S. Mantell, MD, PhD, Assistant Professor of Pediatrics
Format: Article
Language:English
Published: Elsevier 2025-08-01
Series:JHLT Open
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Online Access:http://www.sciencedirect.com/science/article/pii/S2950133425001041
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author Sydney Elizer, MD
Benjamin S. Mantell, MD, PhD, Assistant Professor of Pediatrics
author_facet Sydney Elizer, MD
Benjamin S. Mantell, MD, PhD, Assistant Professor of Pediatrics
author_sort Sydney Elizer, MD
collection DOAJ
description Pediatric heart transplantation (HT) has transformed outcomes for children with end-stage heart failure. Despite advances in surgical techniques and immunosuppressive strategies, mortality remains influenced by numerous risk factors. This review consolidates current literature on pre- and post-transplant variables affecting mortality in pediatric HT, focusing on donor, recipient, and environmental contributors. Pertinent adult studies are also incorporated to highlight overlapping considerations. Recognition of these factors is critical to improving graft survival and long-term outcomes. Key pre-transplant elements include repeated sternotomies, high pulmonary vascular resistance, and extremes of body mass index, while post-transplant issues such as infection, rejection, and cardiac allograft vasculopathy (CAV) remain pivotal. Social determinants of health further modulate survival, reflecting the multifaceted nature of pediatric HT outcomes. By synthesizing existing data, this review aims to provide a framework for identifying high-risk profiles in pediatric HT recipients.
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spelling doaj-art-8025beae7db04e25bcfd23843c42c0912025-08-20T03:02:59ZengElsevierJHLT Open2950-13342025-08-01910030910.1016/j.jhlto.2025.100309Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributorsSydney Elizer, MD0Benjamin S. Mantell, MD, PhD, Assistant Professor of Pediatrics1Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OhioHeart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Corresponding author: Benjamin S. Mantell, MD, PhD, Advanced Cardiomyopathy Program, The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229.Pediatric heart transplantation (HT) has transformed outcomes for children with end-stage heart failure. Despite advances in surgical techniques and immunosuppressive strategies, mortality remains influenced by numerous risk factors. This review consolidates current literature on pre- and post-transplant variables affecting mortality in pediatric HT, focusing on donor, recipient, and environmental contributors. Pertinent adult studies are also incorporated to highlight overlapping considerations. Recognition of these factors is critical to improving graft survival and long-term outcomes. Key pre-transplant elements include repeated sternotomies, high pulmonary vascular resistance, and extremes of body mass index, while post-transplant issues such as infection, rejection, and cardiac allograft vasculopathy (CAV) remain pivotal. Social determinants of health further modulate survival, reflecting the multifaceted nature of pediatric HT outcomes. By synthesizing existing data, this review aims to provide a framework for identifying high-risk profiles in pediatric HT recipients.http://www.sciencedirect.com/science/article/pii/S2950133425001041pediatricsheart transplantheart failurecongenital heart diseasecardiomyopathy
spellingShingle Sydney Elizer, MD
Benjamin S. Mantell, MD, PhD, Assistant Professor of Pediatrics
Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors
JHLT Open
pediatrics
heart transplant
heart failure
congenital heart disease
cardiomyopathy
title Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors
title_full Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors
title_fullStr Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors
title_full_unstemmed Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors
title_short Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors
title_sort risk factors affecting mortality in pediatric heart transplantation a comprehensive review of pre and post transplant contributors
topic pediatrics
heart transplant
heart failure
congenital heart disease
cardiomyopathy
url http://www.sciencedirect.com/science/article/pii/S2950133425001041
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