Heterogeneity is the rule among pediatric heart transplant recipients. Patients vary in age, size, organ maturity, immune system maturity and underlying disease etiology, which can all influence post-transplant outcomes. Overall, the survival of pediatric transplant recipients continues to improve and the goal remains long-term survival of the primary graft and mitigation of long-term complications and adverse events. The evolving fields of pharmacogenomics and genomics have the potential to revolutionize and personalize the care of pediatric transplant recipients, and although clinical validation in a pediatric cohort is lacking, many of these technologies are becoming more readily available. We discuss genotype-guided dosing of immunosuppressant medications and other commonly used medications after transplantation, the influence of donor and recipient genotype on risk of post-transplant complications, genotype-guided selection of therapies to treat complications, and the use of next-generation sequencing for noninvasive detection of graft rejection.
Keywords: cell-free DNA; pediatric cardiac transplantation; pharmacogenomics; statin myopathy; tacrolimus.