Pediatric lung transplantation

Abstract

Purpose of review Lung transplantation for infants and children is an accepted but rarely exercised option for treatment of end-stage lung disease with outcomes equivalent to those for adults. However, widespread misconceptions regarding pediatric outcomes often confound timely and appropriate referral to specialty centers. We present updated information for primary pediatricians to utilize when counseling families with children confronted by progressive end-stage pulmonary or cardiovascular disease. Recent findings We provide general guidelines to consider for referral, discuss allocation of organs in children, information regarding standard treatment protocols, and survival outcomes. Summary Lung transplantation is a worthwhile treatment option to consider in children with end-stage lung disease. The treatment is complex, but lung transplant provides substantial survival benefit and markedly improved quality of life for children and their families. This timely review provides comprehensive information for pediatricians who are considering options for treatment of children with end stage lung disease.

Infantile pulmonary capillary haemangiomatosis: a lethal form of pulmonary hypertension

“…Worldwide experience with infant lung transplantation is much less than that of adults, but the evidence suggests that it is still a viable therapeutic option for infants with end-stage lung disease including pulmonary vascular disease. 13,14 A recent study reported over 80 children who underwent lung transplantation over a 26-year period. 13 They found that overall survival for infants undergoing lung transplantation is comparable with older children and that late survival and survival in certain high-risk cohortsfor example, pretransplant mechanical ventilationappear to be better.…”

“…Pulmonary vascular disease is recorded to be one of the most common indications for infant lung transplantation; however, the percentage of which is pulmonary capillary haemangiomatosis is not reported. [13][14][15] Other therapies have been used with reported success in individual patients. Three paediatric cases of successful treatment in the late 1980s with recombinant alpha interferon have been reported.…”

Selection Criteria for Lung Transplantation: Controversies and New Developments

“…4,26,27 Very Low Age: Pediatric Lung Transplantation Lung transplantation is an accepted option for the treatment of end-stage lung disease in infants and children, but is performed rarely as compared with adult lung transplantation. 32 This results from the smaller number of children with severe pulmonary disease relative to adults. However, the number of children undergoing lung transplantation has also increased over the years (►Fig.…”

“…2). [32][33][34] The major indication for pediatric lung transplantation is cystic fibrosis (CF); other indications include idiopathic pulmonary arterial hypertension and other pulmonary vascular diseases, bronchopulmonary dysplasia, disorders of surfactant metabolism, and diffuse interstitial lung diseases of childhood. 32,33 Most pediatric lung transplants are performed in children aged over 10 years, the main indication being CF (►Fig.…”

Interstitial Lung Disease in Childhood: Clinical and Genetic Aspects

“… 140 The survival rate after LTx is quite similar to the adult rate, and the major causes of early death after LTx are graft rejection and graft dysfunction. 140 , 141 The use of adult allografts for pediatric LTx does not affect the outcomes, 142 and living related adult donor lobe transplant 76 could provide an option in end-stage chILD cases presenting severe respiratory distress.…”