[Pediatric lung transplantation].
Approximately 700 transplants world-wide have been performed in patients aged less than 18 years; in contrast, over 11,000 lung transplants have been performed in adults. The major diagnostic group is cystic fibrosis. An emerging group of patients are infants born with congenitally based pulmonary diseases such as surfactant protein B deficiency. Survival in children is very similar to that in adults, although it is generally perceived that children are at higher risk. For instance, no children have been transplanted for chronic obstructive lung disease (a low-risk diagnostic group) while this disease comprises approximately 40% of all adult lung transplantations. Immunosuppression generally consists of cyclosporine, azathioprine and prednisone. Post-transplant complications in children are similar to those observed in adults. Around 40% of patients will develop bronchiolitis obliterans approximately 3 years after transplantation and this remains the major impediment to long term survival. Donor shortage is also a significant obstacle, especially in adolescents. As a partial solution to this problem, living donor lung transplantation has taken on a greater role in our program. Although this is a complex, expensive treatment strategy, lung transplantation remains the most effective therapy for end-stage pulmonary parenchymal and vascular diseases even in children.
Division of Cardiothoracic Surgey, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA. huddlestonc@msnotes.wustl.edu
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Mallory
D002648:Child; D000075202:Contraindications; D005544:Forecasting; D006801:Humans; D019520:Living Donors; D008168:Lung / Q000502:physiology; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000639:trends; D015996:Survival Rate