Transplantation is now a standard treatment option in end-stage pediatric heart disease. More details on transplantation are provided in Chapter 22, "Organ Transplantation." Children and adolescents who have undergone transplantation continue to face challenges from having a chronic physical illness requiring a lifelong course of immunosuppressive therapy to prevent organ rejection (DeMaso et al. 2004).

Although many youngsters show resiliency and adapt well to heart transplantation, a significant number of others experience difficulties following transplantation, including neurodevelopmental delays, poor adherence to treatments, behavior problems, difficulty in school, and depression (Wray and Radley-Smith 2005). In a longitudinal study of 23 pediatric patients who underwent heart transplantation, 27% demonstrated emotional adjustment difficulties at some point during their medical care (DeMaso et al. 2004). Medical severity and post-transplant psychological functioning were not correlated, but family functioning during the first 2 years after transplantation and posttransplant emotional adjustment were significantly correlated (De

Maso et al. 2004). Given the enhanced risk of psychological difficulties following pediatric heart transplantation, recommendations have been made to add psychological care to a child's ongoing medical and cardiology care to help prevent the development of serious emotional and behavioral difficulties, such as nonadherence, that could potentially interfere with the child's posttransplant survival (DeMaso et al. 2004).

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