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[Pediatric lung transplantation]
C Huddleston1, E Mendeloff, G Mallory
1Division of Cardiothoracic Surgey, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA. huddlestonc@msnotes.wustl.edu
Insights
Pediatric lung transplantation outcomes are similar to adults, despite perceived higher risks. Bronchiolitis obliterans and donor shortage remain key challenges in pediatric lung transplant recipients.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Transplant Immunology
Background:
- Lung transplantation in patients under 18 years old is less common than in adults (700 vs. 11,000+).
- Cystic fibrosis is the primary diagnosis, with congenital pulmonary diseases emerging in infants.
- Children with chronic obstructive lung disease are not typically candidates, unlike adults.
Purpose of the Study:
- To compare pediatric and adult lung transplant outcomes.
- To identify challenges and solutions in pediatric lung transplantation.
- To evaluate the efficacy of lung transplantation for end-stage pediatric lung diseases.
Main Methods:
- Review of pediatric and adult lung transplant data.
- Analysis of diagnostic groups, survival rates, and complications.
- Evaluation of immunosuppression protocols and donor strategies.
Main Results:
- Pediatric lung transplant survival rates are comparable to adults.
- Bronchiolitis obliterans affects approximately 40% of patients around 3 years post-transplant.
- Donor shortage is a significant issue, particularly for adolescents, with living donor transplantation emerging as a solution.
Conclusions:
- Pediatric lung transplantation is a viable and effective treatment for end-stage pulmonary disease.
- Similar complications and survival rates challenge the perception of higher risk in children.
- Addressing bronchiolitis obliterans and donor scarcity is crucial for improving long-term outcomes.
Abstract:
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.