Pediatric lung transplantation: indications and contraindications

As the practice of lung transplantation in children evolves, the indications are expanding. The major diagnostic groups for which transplantation is offered are similar to those used in adult lung transplantation with the notable absence of obstructive lung disease. Of all children under the age of 18 years undergoing lung transplantation, cystic fibrosis accounts for approximately 35%, pulmonary vascular disease, with or without associated congenital heart disease, accounts for 25-30%, and interstitial lung diseases comprise about 10%. The other categories included retransplantation and a variety of diagnoses which by themselves describe an unusual form of end-stage pulmonary disease. The selection of candidates with transplantable diagnoses is crucial, and as this specialty evolves the contraindications have as well. Colonization of the airway with resistant bacterial or fungal organisms, history of multiple prior thoracic procedures, need for mechanical ventilation, diabetes mellitus, and the presence of other organ failure constitute some relative contraindications for transplantation. Retransplantation is a controversial issue that has not yet been resolved.