Complications of pediatric lung and heart-lung transplantation.
As more children receive lung and heart-lung transplants, understanding posttransplantation complications becomes more important. Complications can be categorized as 1) anatomic and surgical, 2) infectious, 3) rejection, 4) posttransplantation lymphoproliferative disease (PTLD), and 5) drug-related. In the early posttransplantation period, reimplantation injury and vascular obstruction with thrombus formation may occur, whereas stenosis at tracheal or bronchial anastomotic sites develops more slowly. Infections in the transplanted lung are common, and can be caused by bacteria, viruses, fungi, or protozoans. Both acute and chronic rejection are potentially serious. Frequent or severe episodes of acute rejection increase the risk of chronic rejection, characterized by obliterative bronchiolitis. Differentiating rejection from infection requires tissue, obtained through transbronchial or open lung biopsy. PTLD, related to Epstein-Barr virus infection, is common in children, and difficult to treat. Finally, drug toxicity from immunosuppressive agents causes considerable morbidity. Increased understanding will continue to improve the outcome for children undergoing lung and heart-lung transplantation.
Kurland
G
G
Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213.
Orenstein
D M
DM
D000208:Acute Disease; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D001992:Bronchoalveolar Lavage Fluid; D002648:Child; D002908:Chronic Disease; D005544:Forecasting; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016041:Heart-Lung Transplantation / Q000009:adverse effects* / Q000379:methods / Q000639:trends; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods / Q000639:trends; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D009017:Morbidity; D012307:Risk Factors; D016896:Treatment Outcome