Temporal Trends in Practice and Outcomes of Pediatric Heart Transplantation

All articles of this category (opens in new window) Background: Pediatric Heart transplantation (HTx) is an established therapy for children with complex congenital heart disease (CHD) and cardiomyopathy. Over the past decades, the field has evolved substantially, with notable changes in patient selection, surgical techniques, and outcomes. This study presents our center’s 36-year experience. Methods: Between 1988 and 2024, we performed 278 pediatric heart transplants in patients with CHD or cardiomyopathy. The cohort was divided into three eras: era 1 (1988–1999), era 2 (2000–2010), and era 3 (2011–2024). Baseline characteristics, perioperative outcomes, and survival were analyzed across eras. Results: In era 1, most recipients were infants (median age 0 years, IQR: 0–1), with CHD accounting for 75% of cases. In the most recent era, older children and adolescents were transplanted more frequently, and cardiomyopathy became the predominant indication (56%). Waitlist times increased in era 2 but slightly decreased in era 3. The use of mechanical circulatory support rose significantly ( p < 0.001), and in the recent era, the bicaval surgical technique has completely replaced the biatrial approach. Post-HTx outcomes improved over time, with significant reductions in 30-day mortality and allograft vasculopathy in the recent era ( p < 0.001). Conversely, pacemaker implantation and elevated pulmonary vascular resistance were observed more frequently in era 3 ( p < 0.001). Long-term survival did not differ significantly across eras. Conclusion: Over the past three decades, pediatric HTx has evolved with clear improvements in early survival and reduced allograft vasculopathy. Shifts in patient demographics, surgical technique, and increasing use of MCS reflect ongoing progress while underscoring persistent challenges in this complex population. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany