Pushing the Frontier in Pediatric Heart Transplantation: Innovation Across Immunology, Organ Utilization, and Bioengineering

Purpose of Review: Pediatric heart transplantation remains the definitive therapy for children with end-stage heart failure and irreparable congenital heart disease, but remains limited by donor scarcity, lifelong immunosuppression, and non-growing valve replacement options. This review examines emerging strategies that may address these barriers. Recent Findings: Advances in immune tolerance, including thymus-heart co-transplantation, may reduce or eliminate the need for chronic immunosuppression. Partial heart transplantation introduces living valve tissue capable of somatic growth, addressing a major limitation of existing prosthetic and bioprosthetic valves. Donation after circulatory death, normothermic regional perfusion, and on-table reanimation are expanding access to transplantable organs. Xenotransplantation and genetically engineered donor organs may further overcome donor availability constraints. Summary: These innovations suggest a transition toward a pediatric heart transplantation paradigm centered on biological integration, organ stewardship, and precision immunology. Further research is needed to define durability, immunologic consequences, feasibility, and long-term outcomes.

Duke Scholars

Author Joseph W Turek Surgery, Cardiovascular and Thoracic Surgery

Author Douglas Overbey Surgery, Cardiovascular and Thoracic Surgery