PEDIATRIC LUNG TRANSPLANTATION

Lung transplantation has become an established therapeutical option fo r treatment of end stage pulmonary insufficiency. In pediatric patient s lung transplantation can also be performed as single lung transplant ation (SLTx), bilateral or double lung transplantation (DLTx) or combi ned heart-lung transplantation (HLTx). Restrictive pulmonary disease c an be treated with SLTx. In obstructive-infectious disease DLTx is per formed. Combined heart lung transplantation is considered in case of a dditional irreversible myocardial dysfunction or incorrectable congeni tal heart disease. 177 SLTx and DLTx as well as 266 HLTx in children ( up to 18 years of age) were reported worldwide until the end of 1994. With an actual survival rate of 64% one year after transplantation, th e outcome remains significantly inferior to that in adults. Major risk factors in the early course are acute rejection and infection. In con trast, chronic rejection represents the single most important limiting factor for life long term expectancy. Immunosuppression in the pediat ric patient is generally based on Cyclosporine-A and Azathioprine. In addition to limited long term results, the shortage of donor organ ava ilability prevents a further increase of lung transplantation in pedia tric patients. For this reason, transplantation of lobes from organ do nors or relatives to the recipient have been performed in selected cas es. So far these procedures are to be considered as experimental. To a chieve a higher availability of donor organs as well as improvement of results in pediatric lung transplantation, an intensive development i n organ donor availability and progress in immunosuppressive therapy a re required.