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[Lung transplantation in children]
M O Hoekstra1, W van der Bij, W J de Boer
1Afd. Kinderlongziekten, academisch Ziekenhuis, Groningen.
Insights
Lung transplantation offers a lifeline for chronic respiratory insufficiency, but faces challenges like donor shortages and rejection. Survival rates vary, emphasizing the need for careful patient selection and management.
Area of Science:
- Medicine
- Pulmonology
- Transplant Surgery
Background:
- Lung transplantation has been performed in the Netherlands since 1990 for chronic respiratory insufficiency.
- Pediatric lung transplants are predominantly for cystic fibrosis, with significant pre-transplant attrition.
- Donor lung scarcity leads to prolonged waiting times, exceeding one year.
Purpose of the Study:
- To review the outcomes and challenges of lung transplantation in adults and children.
- To highlight the complexities of pediatric lung transplantation, including patient selection and post-operative care.
- To discuss survival rates and complications associated with lung transplantation.
Main Methods:
- Retrospective analysis of lung transplantation cases in the Netherlands.
- Review of patient referral, selection, and waiting list data.
- Analysis of post-operative outcomes, including rejection rates, complications, and survival statistics.
Main Results:
- Approximately one-third of referred pediatric patients undergo transplantation.
- Acute rejection occurs in most patients, with chronic rejection in 20-40%.
- One, two, and four-year survival rates range from 60-70%, 55-60%, and 30-50%, respectively.
Conclusions:
- Lung transplantation is a viable but complex treatment for chronic respiratory insufficiency.
- Patient selection, management of rejection, and addressing donor shortages are critical for improving outcomes.
- Timely referral and good pre-transplant condition are positive prognostic indicators.
Abstract:
The first lung transplantation in the Netherlands was carried out in 1990. Since, the operation has been performed in over one hundred adults and two children (up to 16 years) with chronic respiratory insufficiency. Most lung transplantations in children are performed because of cystic fibrosis. After referral, the patient is given information about the operation and the pre- and postoperative periods, and the transplantation team advises on the time of screening. Some one-third of the children referred ultimately undergo transplantation; the others refrain from the operation, are rejected or die during the waiting period. Owing to a shortage of donor lungs the waiting period for transplantation may last over one year. A possible but controversial solution is donation of a pulmonary lobe by a close relative. Undergoing lung transplantation places a heavy (psychic) burden on the patient and his parents. Every patient after lung transplantation goes through an average of two or three periods of acute rejection. Chronic rejection occurs in 20-40%. Other complications are connected to medication (infections, renal dysfunction) or to the underlying disease (diabetes mellitus in cystic fibrosis). The percentages of survival for 1, 2 and 4 years are approx. 60-70, 55-60 and 30-50, dependent in part on the type of lung transplantation (unilateral, bilateral or combined heart-lung transplantation). A reasonable condition of the patient owing to timely referral is a positive prognostic factor.