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Since the first transplant was performed in 1967, the number of transplants has grown dramatically with 13\u2009449 pediatric heart transplants being reported to The International Society of Heart and Lung Transplant (ISHLT) between January 1992 and June 30, 2018. Outcomes have consistently improved over the last few decades, specifically short\u2010term outcomes. Most recent survival data demonstrate that recipients who survive to 1\u2010year post\u2010transplant have excellent long\u2010term survival with more than 60% of those who were transplanted as infants being alive 25\u2009years later. Nonetheless, the rates of graft loss beyond the first year have remained relatively constant over time; driven primarily by our poor understanding and lack of treatments for chronic allograft vasculopathy (CAV). Acute rejection, CAV, graft failure, and infection continue to be the major causes of death within the first 5\u2009years post\u2010transplant. In addition, renal dysfunction, malignancy, and the need for re\u2010transplantation remain as significant issues that require close follow\u2010up. Looking forward, key challenges include improving donor utilization rates (including donation after cardiac death (DCD) and the use of ex\u00a0vivo perfusion devices), the development of non\u2010invasive biomarkers for rejection, efforts to mitigate the long\u2010term effects of immunosuppression, and prevention of CAV. It is not possible to cover the entire evolution of pediatric heart transplantation over the last five decades, but in this review, we hope to touch on key observations, lessons learned, and practice changes that have advanced the field, as well as glance ahead to the next decade.<\/jats:p>","DOI":"10.1111\/petr.14675","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T09:36:13Z","timestamp":1702028173000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Pediatric heart transplantation: Looking forward after five decades of learning"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6323-7222","authenticated-orcid":false,"given":"Anne I.","family":"Dipchand","sequence":"first","affiliation":[{"name":"Department of Paediatrics Head, Heart Transplant, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4865-5666","authenticated-orcid":false,"given":"Steven A.","family":"Webber","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Vanderbilt University School of Medicine, Pediatrician\u2010in\u2010Chief, Monroe Carell Jr. Children's Hospital at Vanderbilt  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,8]]},"reference":[{"issue":"48","key":"e_1_2_12_2_1","first-page":"1271","article-title":"The operation. 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