Have we met the expectations of heart and lung transplantation in children?
Heart transplantation in children has been a relatively common practice for more than 15 years, and lung transplantation, while in use as a therapeutic modality for a shorter period of time, has 10 years of follow-up data for review. Because they are expensive, time-consuming, labor-intensive procedures, it is reasonable to review what has transpired to evaluate the effectiveness of these procedures, not only from the standpoint of survival, but in the applicability and availability to all who need it, and successful long-term outcomes including quality of life in those who receive it. Health care expense can be justified by improved results that reach expectations in the areas of applicability, availability, and survival. The applicability issue has, in large part, been achieved in transplantation in children. The goal of comprehensive availability can be met by providing alternatives to transplantation, advancing artificial organ research, and overhauling the organ donor programs to improve organ retrieval. To better meet expectations for survival, further advances in transplant immunology and solutions to the problems of post-transplant coronary artery disease and bronchiolitis obliterans will have to occur.
Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA.
Charles B
CB
Huddleston
D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000191:economics / Q000401:mortality / Q000592:standards*; D016041:Heart-Lung Transplantation / Q000191:economics / Q000401:mortality / Q000592:standards; D006801:Humans; D016040:Lung Transplantation / Q000191:economics / Q000401:mortality / Q000592:standards*; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011787:Quality of Health Care; D011788:Quality of Life; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States