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Updated: Dec 4, 2025
Left Lung Orthotopic Transplantation in a Juvenile Porcine Model for ESLP
Published on: February 14, 2022
Pediatric lung transplantation as standard of care
Raphael Werner1, Christian Benden2,3
1Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Insights
Pediatric lung transplantation offers good long-term outcomes for children with advanced lung disease. This review updates on referral, life support, donor organs, and managing chronic lung allograft dysfunction (CLAD).
Area of Science:
- Pediatric Pulmonology
- Transplant Surgery
- Immunology
Background:
- Lung transplantation is a critical treatment for pediatric patients with end-stage lung disease.
- Recent advancements have significantly improved long-term outcomes in pediatric lung transplantation, rivaling adult results.
Purpose of the Study:
- To provide an updated review of pediatric lung transplantation.
- To cover key aspects including referral, assessment, bridge-to-transplantation strategies, donor organ limitations, and post-transplant management.
Main Methods:
- This is a review article, synthesizing current knowledge and evidence in pediatric lung transplantation.
- Key areas discussed include donor organ acceptability, surgical techniques for size reduction, immunosuppression protocols, and management of chronic lung allograft dysfunction (CLAD).
Main Results:
- Pediatric lung transplant outcomes are comparable to adult outcomes.
- Challenges remain, including donor organ scarcity and the management of chronic lung allograft dysfunction (CLAD).
- Immunosuppression requires careful monitoring due to scarce evidence-based data and frequent side effects.
Conclusions:
- Pediatric lung transplantation is a viable option with improving outcomes.
- Addressing donor organ limitations and optimizing CLAD management are crucial for future success.
- Individualized immunosuppression strategies and careful patient selection for re-transplantation are vital.
Abstract:
For infants, children, and adolescents with progressive advanced lung disease, lung transplantation represents the ultimate therapy option. Fortunately, outcomes after pediatric lung transplantation have improved in recent years now producing good long-term outcomes, no less than comparable to adult lung transplantation. The field of pediatric lung transplantation has rapidly advanced; thus, this review aims to update on important issues such as transplant referral and assessment, and extra-corporal life support as "bridge to transplantation". In view of the ongoing lack of donor organs limiting the success of pediatric lung transplantation, donor acceptability criteria and surgical options of lung allograft size reduction are discussed. Post-transplant, immunosuppression is vital for prevention of allograft rejection; however, evidence-based data on immunosuppression are scarce. Drug-related side effects are frequent, close therapeutic drug monitoring is highly advised with an individually tailored patient approach. Chronic lung allograft dysfunction (CLAD) remains the Achilles' heel of pediatric lung transplant limiting its long-term success. Unfortunately, therapy options for CLAD are still restricted. The last option for progressive CLAD would be consideration for lung re-transplant; however, numbers of pediatric patients undergoing lung re-transplantation are very small and its success depends highly on the optimal selection of the most suitable candidate.
