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Lung transplantation in children
Jonas Peter Ehrsam1,2,3, Olga Meier Adamenko3, Manjinder Pannu4
1School of Medicine, University of Zurich, Zurich, Switzerland.
Insights
Pediatric lung transplantation offers hope for children with severe lung disease. While organ shortage is a challenge, techniques like using smaller lungs improve survival, with over 10 years possible in experienced centers.
Area of Science:
- Pediatric surgery
- Thoracic transplantation
- Pulmonology
Background:
- Lung transplantation is a vital treatment for pediatric advanced lung disease and pulmonary vascular disorders.
- Organ shortage presents a significant challenge in pediatric lung transplantation.
- Techniques like using downsized adult lungs, lobes, or segments have been developed to fit children's smaller chests.
Purpose of the Study:
- To summarize the current state of pediatric lung transplantation.
- To highlight survival rates and challenges in pediatric lung transplant recipients.
- To discuss factors influencing outcomes in pediatric lung transplant patients.
Main Methods:
- Review of established pediatric lung transplantation procedures.
- Analysis of survival data based on age, disease, and center experience.
- Identification of key challenges in the peri- and post-transplant phases.
Main Results:
- Worldwide median survival after pediatric lung transplantation is 5.7 years.
- Median survival exceeding 10 years is achievable, particularly with consideration of patient age, disease, and center expertise.
- Downsized adult lungs, lobes, or segments are successfully transplanted into children.
Conclusions:
- Pediatric lung transplantation is a feasible treatment option for end-stage lung disease in children.
- Optimizing referral timing and managing complications like ischemia-reperfusion injury and rejection are crucial for long-term success.
- Further advancements are needed to overcome organ shortage and improve outcomes in pediatric lung transplant recipients.
Abstract:
Lung transplantation is a well-established treatment for children facing advanced lung disease and pulmonary vascular disorders. However, organ shortage remains highest in children. For fitting the small chest of children, transplantation of downsized adult lungs, lobes, or even segments were successfully established. The worldwide median survival after pediatric lung transplantation is currently 5.7 years, while under consideration of age, underlying disease, and peri- and posttransplant center experience, median survival of more than 10 years is reported. Timing of referral for transplantation, ischemia-reperfusion injury, primary graft dysfunction, and acute and chronic rejection after transplantation remain the main challenges.
