67 - Pediatric Lung Transplantation

Abstract

Indications for pediatric lung transplantation vary by age, with some conditions leading to transplant throughout childhood (e.g., pulmonary hypertension) and others predominating in younger (e.g., surfactant disorders) or older (e.g., cystic fibrosis) children. The use of the “Lung Allocation System” has resulted in shorter waiting list times and also in sicker children proceeding to lung transplant. The number of absolute contraindications to transplant has diminished as centers develop greater expertise. Strategies such as extracorporeal membrane oxygenation (ECMO) are being used as a “bridge” to transplant in some patients with severe lung disease. Patients who undergo lung transplant require lifetime immunosuppression, which increases their ongoing risk of infection. Acute rejection can occur in the period immediately following transplant. Medication side effects, particularly renal dysfunction, become increasingly common over the years following transplant. Malignancies are relatively uncommon as a complication of transplant, but posttransplant lymphoproliferative disorder (PTLD), a form of lymphoma often associated with Epstein-Barr virus (EBV), can occur months or years following transplant. Complications such as chronic lung allograft dysfunction (CLAD) become increasingly common in the years following transplant. Treatment for CLAD is challenging, and this complication limits long-term allograft survival. Average survival in pediatric lung transplantation is just over five years. Extending patient survival and improving organ supply will be vital to the future of the field.