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Posttransplant monitoring of pediatric lung transplant recipients
Gary A Visner1, Samuel B Goldfarb
1Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA. visner@email.chop.edu
Insights
Pediatric lung transplant recipients require careful monitoring for complications like rejection and infection. New immune monitoring assays and tracking of de-novo antibodies and reflux may improve long-term survival in these patients.
Area of Science:
- Pulmonology
- Transplant Surgery
- Immunology
Background:
- Lung transplantation is a critical treatment for end-stage lung disease in children.
- Post-transplant management aims to prevent and manage complications, optimizing patient survival.
- Long-term outcomes in lung transplantation have seen limited improvement.
Purpose of the Study:
- Review current pediatric lung post-transplant management strategies.
- Identify existing challenges and pitfalls in current care.
- Introduce novel parameters impacting long-term survival.
Main Methods:
- Review of current trends in pediatric lung transplant management.
- Analysis of routine monitoring parameters: laboratory studies, imaging, drug levels, and pulmonary function tests.
- Inclusion of newer monitoring techniques: immune status assays (e.g., ImmuKnow), de-novo donor-specific antibodies, and gastroesophageal reflux monitoring.
Main Results:
- Standard monitoring helps detect early complications but may not fully reflect immune status.
- Bronchoscopy is crucial for differentiating rejection from infection, with surveillance bronchoscopies addressing silent rejection.
- Emerging factors like de-novo anti-histocompatibility locus antigen antibodies and gastroesophageal reflux are linked to poorer outcomes.
Conclusions:
- Current monitoring methods are essential for maintaining outcomes post-lung transplant.
- Additional parameters, including immune monitoring and assessment of specific complications, are being integrated.
- These enhanced monitoring strategies hold promise for improving long-term survival in pediatric lung transplant recipients.
Purpose Of Review:
This article reviews current trends in pediatric lung posttransplant management, reveals pitfalls that exist, and introduces additional parameters that may have an impact on long-term survival.
Recent Findings:
A number of parameters are monitored after transplantation to prevent or identify early complications related to lung transplantation in hope of reducing morbidity and mortality. These include routine laboratory studies, imaging, and monitoring of drug levels and lung function. Drug monitoring allows individualization of a patient's immunosuppressive therapy; however, drug levels alone may not reflect the patient's immune status. ImmuKnow is a general immune-monitoring assay that may help guide therapy. Two major complications are rejection and infection, and bronchoscopy is used to differentiate these two entities. Silent rejection may occur and increase the chance of developing bronchiolitis obliterans; therefore, many centers perform surveillance bronchoscopies. Recently, de-novo anti-histocompatibility locus antigen antibodies and gastroesophageal reflux have been associated with poor outcomes, and many centers are monitoring these entities as part of care following lung transplant.
Summary:
There has been little improvement in long-term outcomes of lung transplantation. Current monitoring methods are utilized to maintain or improve outcomes and recently additional monitoring parameters have been identified which hopefully will improve long-term outcomes.
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