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Critical issues in pediatric lung transplantation
J M Armitage1, G Kurland, M Michaels
1University of Pittsburgh Medical Center, PA 15213.
The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1995
Summary
Pediatric lung transplantation survival rates improved with focused management of cytomegalovirus, obliterative bronchiolitis, and post-transplant lymphoproliferative disease. Strategies for cystic fibrosis and airway complications were also refined.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Transplant Immunology
Background:
- Pediatric lung transplantation is a complex procedure with varying indications including congenital heart disease, cystic fibrosis, and pulmonary hypertension.
- Survival rates and management strategies for pediatric lung transplant recipients require continuous evaluation and refinement.
Purpose of the Study:
- To review critical issues impacting patient and program survival in pediatric lung transplantation.
- To analyze outcomes and management strategies for specific complications such as cytomegalovirus disease, obliterative bronchiolitis, and post-transplantation lymphoproliferative disease.
Main Methods:
- Retrospective review of 40 pediatric lung transplant cases (heart-lung, double lung, single lung) performed between 1985 and April 1994.
- Analysis of patient data focusing on indications for transplantation, complications, and survival rates.
- Evaluation of management strategies for cytomegalovirus, obliterative bronchiolitis, post-transplantation lymphoproliferative disease, cystic fibrosis, and airway issues.
Main Results:
- Overall 1-year actuarial survival was 73%, with variations by disease group (60% for cystic fibrosis to 90% for congenital heart disease).
- Cytomegalovirus disease occurred in 23% of long-term survivors; obliterative bronchiolitis in 25%, and post-transplantation lymphoproliferative disease in 15%.
- Modified strategies for cystic fibrosis patients eliminated infectious mortalities, and airway complications were minimal in heart-lung recipients.
Conclusions:
- Critical issues in pediatric lung transplantation include managing cytomegalovirus, obliterative bronchiolitis, and post-transplantation lymphoproliferative disease.
- Refined management strategies, particularly for cystic fibrosis, can improve outcomes and reduce infectious complications.
- Continued focus on these critical areas is essential for enhancing patient and program survival in pediatric lung transplantation.