Preface: Optimization of Outcomes for Children After Solid Organ Transplantation

Abstract

Solid organ transplantation is a life-saving treatment option for end-stage organ failure in children. With excellent graft and patient survival reported from all arenas of pediatric solid organ transplantation worldwide, it is not surprising, and entirely appropriate, that the success of pediatric solid organ transplantation in children is being defined by more than just survival rates. Conceptually, pediatric solid organ transplantation can be viewed as the replacement of a fatal disease with a chronic condition that poses its own risks of medical and psychosocial comorbidities—developing in spite of reinstated function of the previously failed native organ and recovery from the complications of end-stage organ disease. The commonly quoted mantra, ‘‘children are not simply little adults,’’ is never more true than in the care of transplant recipients: pediatric transplant recipients, by nature of their young age, face a greater cumulative burden of lifelong immunosuppression and its ensuing complications. With the population of long-term survivors after pediatric transplantation ever increasing and greatly exceeding the numbers of newly transplanted recipients each year, all health care providers will undoubtedly find themselves encountering these special patients. A collaborative partnership and coordinated approach among primary care practitioners, pediatric health care providers, and allied health professionals both within and beyond the walls of the Pediatric Transplant program, as well as a commitment to selfmanagement by patients and families, are essential ingredients to optimizing the long-term care and best outcomes for these children. This issue of Pediatric Clinics of North America is devoted to providing up-to-date, concise (and practical) reviews of the most common clinical issues confronting children who have undergone pediatric solid organ transplantation. The first 5 articles provide an overview and status update of pediatric heart, liver, kidney, lung, and small bowel transplantation in 2010. The next 5 articles address