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2015 ; 28
(4
): 237-243
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Lung Transplantation in Cystic Fibrosis: Trends and Controversies
#MMPMID26697265
Blatter J
; Sweet S
Pediatr Allergy Immunol Pulmonol
2015[Dec]; 28
(4
): 237-243
PMID26697265
show ga
This article is not an overview of all facets of lung transplantation in cystic
fibrosis (CF), but rather it is intended as a review of current allocation
controversies, as well as of trends in diagnostics and management in lung
transplant recipients and in patients with end-stage lung disease. Despite
changes in donor and recipient selection, long-term survival in pediatric lung
transplant has continued to be limited by chronic lung allograft dysfunction
(CLAD). Due to, in part, this short survival benefit, transplant continues to be
an appropriate option for only a subset of pediatric patients with CF. The
feasibility of transplant as a therapeutic option is also affected by the limited
pediatric organ supply, which has moreover contributed to controversy over lung
allocation. Debates over the allocation of this scarce resource, however, may
also help to drive innovation in the field of lung transplant. Longer
pretransplant survival-as aided by new lung bypass technologies, for
example-could help to alleviate organ shortages, as well as facilitate the
transport of organs to suitable pediatric recipients. Improved diagnosis and
treatment for CLAD and for antibody-mediated rejection have the potential to
extend survival in pediatric lung transplant. Regardless, the relative rarity of
transplant could pose future challenges for pediatric lung transplant programs,
which require adequate numbers of patients to maintain proper expertise.