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Shared care in paediatric heart transplantation
  1. J Simmonds,
  2. M Burch
  1. Department of Cardiology, Great Ormond Street Hospital, London, UK
  1. Dr J Simmonds, Department of Cardiology, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; simmoj{at}gosh.nhs.uk

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The follow-up of paediatric heart transplant recipients is of vital importance to their short- and long-term health. With increasing numbers of transplants and better survival rates, more out-patient care is being performed at a local level. Both GPs and general paediatricians must have a thorough working knowledge of post-transplant medicine if they are to care effectively for these children. It is also essential for paediatric cardiologists to be vigilant for subtle signs of potentially catastrophic complications in these patients.

This article discusses current protocol in paediatric heart transplant, by examining the physiology, pathology and clinical presentation of the post-transplant recipient. It provides advice on running an out-patient clinic and successful management of acute presentations. It concludes that improvements in the understanding of transplantation can only be beneficial to individual patients if their specialist and local teams are knowledgeable about transplant, committed to the prevention of complications, and working in harmony with one another.

INTRODUCTION

Paediatric heart transplantation is a small and highly specialised field of medicine. Over the last five years Great Ormond Street Hospital has performed more heart transplants in children than any other centre in the world, yet the numbers at follow-up remain small (<200). Despite improvements in post-transplant medicine these children remain susceptible to many cardiac and non-cardiac complications which, if left unchecked, may quickly become serious or life-threatening. The follow-up of these patients is thus of paramount importance to both their short- and long-term health.

The need to optimise shared care in this setting is therefore obvious. Patients and families require a local service that will provide them with immediate and effective care, without having to travel long distances to specialist centres. The majority of presentations are comfortably dealt with by a well-informed general paediatric team initially, although prompt communication with the tertiary centre is advised for …

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