Heart transplantation in survivors of childhood cancer

Svetlana B. Shugh, Thomas D. Ryan


There are approximately 450,000 survivors of childhood cancer due, in large part, to successes of therapeutic regimens. With this success comes an increase in the number of patients developing cardiotoxicity as a result of cancer therapies. In certain cases, this includes heart failure recalcitrant to medical therapy, and consideration for heart transplantation may be necessary. However, this group of patients has unique comorbidities that may affect outcomes. Despite this, available data show that complications and overall survival are similar for patients transplanted for anthracycline-induced cardiomyopathy compared to those with other cardiomyopathies, demonstrating that this is a viable treatment option for this population. As other cancer therapies become more common, new cardiovascular toxicities are recognized. Whether heart transplantation will be appropriate for all patients with cancer-therapy related cardiotoxicity (CTRC) will require demonstration of similarly good outcomes to ensure proper allocation of organs.