An overview of paediatric lung transplantation.
Paediatric lung transplantation is indicated in selected children with end-stage lung disease that is not amenable to conventional medical or surgical therapy. The indications and complications differ from adult lung transplant patients. Due to the long waiting times for suitable cadaveric lungs, other types of lung transplantation, such as living donor lobar and split-lung procedures, have been utilised in paediatric patients. Unlike adult candidates, cystic fibrosis and primary pulmonary hypertension are the primary indications. Most recipients are in the adolescent age group. Complications that occur with greater frequency in paediatric lung recipients include somatic growth and graft function, post-transplant lymphoproliferative disease and medical non-adherence. While long-term outcome remains similar between adult and paediatric lung transplant recipients, there is a lower risk of bronchiolitis obliterans in very young recipients and in those who receive living donor lobar lung transplantation. Research into these clinical problems is hampered by the fact that only a small number of paediatric transplants are performed at each centre. Hence, improvement in outcome for these children will be dependent on developing methods to produce better tolerance, understanding the mechanisms/treatment of bronchiolitis obliterans and multi-centre studies that focus on the problems that primarily affect the paediatric lung transplant recipient.
Woo
Marlyn S
MS
Cardiothoracic Transplant Center, Childrens Hospital Los Angeles and Keck School of Medicine at the University of Southern California, Los Angeles, California 90027, USA. mwoo@chla.usc.edu
D000367:Age Factors; D002648:Child; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation; D018579:Patient Selection