Transplantation for congenital heart disease.

Refinements in surgical technique, donor and recipient myocardial preservation, and immunosuppression have brought pediatric heart transplantation for end-stage heart failure (whatever the cause) from the heyday of clinical experimentation to the realm of a viable therapeutic. Heart transplantation in this subpopulation yields excellent early and midterm survival. Acute rejection remains an important cause of morbidity and mortality after heart transplantation in children. Future improvement in quality of life for these patients calls for newer immunosuppressive strategies to reduce acute rejection episodes and ultimately improve long-term graft survival.