Pathogenesis of cardiac graft failure in children*

For many critical cardiac conditions such as cardio-myopathy, congenital heart defects, or arrhythmo-genic disorders, cardiac transplantation is often an accepted treatment with optimistic one- and five-year survival rates of 90 % and 75 % in the pediatric pa-tient population, respectively. However, poor long-term survival is a cause for concern, with cardiac graft failure being the leading cause in late mortality transplant recipients. Cardiac graft failure occurs through several mechanisms. However, the most com-mon causes include cardiac allograft vasculopathy, myocardial fibrosis, and fibrofatty changes. Risk fac-tors exacerbate these mechanisms through rejection, immunosuppressive drug side effects, hypertension, diabetes mellitus, renal dysfunction, and viral infec-tion to increase the chance of cardiac graft failure. Changes in expression levels of various genes offer diagnostic potential for the future of cardiac trans-plantation. Through a comprehensive review of how multiple factors can lead a cardiac graft into failure, we hope to contribute to the longevity of cardiac grafts and pediatric heart transplant recipients