title: Lung and heart-lung transplantation in children and adolescents: a long-term single-center experience.
abstract: BACKGROUND
  Pediatric lung transplantation (LTx) remains a challenge for a highly selected group of patients. The requirements for immunosuppressive therapy and the associated risks must be weighed against the long-term prognosis of this operation. Therefore, we retrospectively analyzed our experience after 53 lung and heart-lung transplantations (HLTx) in children.
  
  
  METHODS
  All pediatric patients <18 years of age who underwent LTx (n = 37) and HLTx (n = 16) at our institution were included in this study. We analyzed indications for transplantation, survival rates and causes of death. Herein we assess pediatric-specific challenges in comparison to adults.
  
  
  RESULTS
  Thirty-day mortality was 13.2%. Kaplan-Meier survival rates at 1, 3, 5 and 10 years were 69%, 64%, 44% and 39%, respectively. Main indications for transplantation were cystic fibrosis and congenital heart disease with Eisenmenger syndrome. Other diagnoses were retransplantation, primary pulmonary hypertension and pulmonary fibrosis. The main causes of death were infection and chronic graft failure. Reduced-size transplantation was performed in 42% of double-lung transplantation (DLTx) patients without negatively impacting survival. Six patients received pulmonary retransplantation, 1 of whom died early.
  
  
  CONCLUSIONS
  Pediatric transplantation is a feasible therapeutic option when undertaken by an experienced team. It should be offered to the small patient population suffering from end-stage pulmonary disease. The limited number of pediatric donor organs can be overcome by using reduced-size organs. However, the management of pediatric-specific complications and therapeutic requirements is essential for positive long-term results after LTx in these patients.
authors.affiliation: Department of Cardiothoracic, Hannover Medical School, Germany. goerler.adelheid@mh-hannover.de
authors.forename: Heidi
authors.initials: H
authors.lastname: Görler
authors.forename: Martin
authors.initials: M
authors.lastname: Strüber
authors.forename: Manfred
authors.initials: M
authors.lastname: Ballmann
authors.forename: Carsten
authors.initials: C
authors.lastname: Müller
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gohrbandt
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Andre
authors.initials: A
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D016041:Heart-Lung Transplantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors