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2017 ; 9
(8
): 2675-2683
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Pediatric lung transplantation
#MMPMID28932575
Benden C
J Thorac Dis
2017[Aug]; 9
(8
): 2675-2683
PMID28932575
show ga
Pediatric lung transplantation has been undertaken since the 1980s, and it is
today considered an accepted therapy option in carefully selected children with
end-stage pulmonary diseases, providing carefully selected children a net
survival benefit and improved health-related quality of life. Nowadays, >100
pediatric lung transplants are done worldwide every year. Here, specific
pediatric aspects of lung transplantation are reviewed such as the surgical
challenge, effects of immunosuppression on the developing pediatric immune
system, and typical infections of childhood, as it is vital to comprehend that
children undergoing lung transplants present a real challenge as children are not
'just small adults'. Further, an update on the management of the pediatric lung
transplant patient is provided in this review, and future challenges outlined.
Indications for lung transplantation in children are different compared to
adults, the most common being cystic fibrosis (CF). However, the primary
diagnoses leading to pediatric lung transplantation vary considerably by age
group. Furthermore, there are regional differences regarding the primary
indication for lung transplantation in children. Overall, early referral, careful
patient selection and appropriate timing of listing are crucial to achieve real
survival benefit. Although allograft function is to be preserved,
immunosuppressant-related side effects are common in children
post-transplantation. Strategies need to be put into practice to reduce
drug-related side effects through careful therapeutic drug monitoring and
lowering of target levels of immunosuppression, to avoid acute-reversible and
chronic-irreversible renal damage. Instead of a "one fits all approach", tailored
immunosuppression and a personalized therapy is to be advocated, particularly in
children. Further, infectious complications are a common in children of all ages,
accounting for almost 50% of death in the first year post-transplantation.
However, chronic lung allograft dysfunction (CLAD) remains the major obstacle for
improved long-term survival.
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