Congenital heart disease (CHD) represents the most prevalent form of birth defect worldwide and has emerged as a leading indication for pediatric heart transplantation. With significant advances in surgical palliation, a growing number of patients with complex CHD are surviving into adulthood, but many ultimately develop heart failure or experience failure of previous palliative surgeries, necessitating transplantation. Heart transplantation in CHD patients is uniquely challenging due to anatomic complexity, prior surgical scarring, and high rates of pretransplant sensitization, all of which contribute to higher perioperative risk and variable long-term outcomes compared to non-CHD recipients. In this review, we performed a comprehensive literature search using PubMed, Scopus, and Web of Science databases, focusing on studies published from 2000 to 2024, and included relevant international guidelines and registry data to synthesize the current knowledge on indications, surgical strategies, immunologic considerations, and posttransplant outcomes in CHD. Unlike prior reviews that have largely focused on Western cohorts, this review integrates the global data with a particular emphasis on low- and middle-income countries (LMICs) such as India, highlighting disparities in access, outcomes, and future directions for equitable care. There is an urgent need for strategies to improve the early identification and referral of candidates, personalized immunosuppression protocols, advanced surgical simulation tools, and robust data collection from LMIC to inform global practice and improve outcomes. Investing in capacity building and adapting international best practices to the local context could substantially enhance the survival and quality of life for CHD transplant recipients worldwide.
Neda Ćićarić (Thu,) studied this question.