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Cardiac transplant – refractory HF — RACP Paediatrics MCQ

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ModerateCardiologyCardiac transplant – refractory HFRACP Paediatrics

A 4-year-old with dilated cardiomyopathy has progressive heart failure refractory to maximal medical therapy (frusemide, captopril, carvedilol, spironolactone). EF is 10%. He is ventilator-dependent in PICU. What is the definitive long-term management option?

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Correct answer: A — Paediatric cardiac transplant

Paediatric cardiac transplantation is the definitive treatment for end-stage heart failure refractory to medical management. In children, 5-year survival post-transplant is ~80%. ABO-compatible or ABO-incompatible (in infants <2 years) donor hearts can be used. While awaiting transplant, mechanical circulatory support (VAD) may be needed as a bridge.

Reference: RCH Melbourne – 2023 – Heart Failure CPG; RACP Paediatric Curriculum – Cardiology