Journal of Clinical and Experimental Transplantation
Open Access

Indications for lung transplants in children are different compared to adults. In adults, the foremost frequent primary indication for lung transplantation is chronic obstructive pulmonary disease (COPD) with one-third of all procedures, followed by interstitial lung disease (ILD) and CF as described elsewhere. In children, the general leading diagnosis for lung transplantation is end-stage CF pulmonary disease; nevertheless, indications vary by age. In children but 1 year aged, congenital heart condition (CHD) is that the most frequent underlying disease. In children aged 1 to 10 years aged, end-stage CF pulmonary disease and idiopathic pulmonary arterial hypertension (IPAH) are the foremost frequent primary indications for lung transplants. In older children and adolescents, CF is commonest.

In children, lung re-transplants are rarely performed. Over the last 20 years, only 100 pediatric lung re-transplant are reported to the ISHLT Thoracic Transplant Registry, predominately from North America. Re-transplantation is predominantly undertaken in older children and adolescents and more frequently administered beyond the primary 12 months after primary transplantation. In most youngsters, chronic lung allograft dysfunction (CLAD), primarily bronchiolitis obliterans syndrome (BOS), is that the underlying cause resulting in lung re-transplants.

Pediatric heart-lung transplantation is extremely rarely performed nowadays, with but 10 procedures per annum reported to the ISHLT Thoracic Transplant Registry in recent years. Heart-lung transplants in children are only performed in only a few centers. The overwhelming majority of pediatric heart-lung transplant procedures are undertaken in children with IPAH, during a minority in those children suffering with CHD.

In general, all children with end-stage parenchymal and vascular pulmonary diseases on maximal medical treatment should be mentioned a transplant program for lung transplant assessment if the anticipated anticipation is below 2 years. On the entire, the anticipated anticipation without lung transplantation has got to be balanced with the expected post-transplant survival, taking under consideration the potential time on a roll, which might be particularly longer for youngsters thanks to the overall lack of suitable smaller donor organs. In Europe, children would presumably be mentioned an adult transplant center with pediatric experience for transplant evaluation, in North America, generally to a pediatric transplant program. So as to maximize internet survival advantage of lung transplantation because the ultimate therapy option in children with advanced pulmonary disease, careful candidate selection is completely critical. The ISHLT Pulmonary Council has recently published an update on guidelines for referral and selection of lung transplant candidates, for the primary time ever, including a general guidance on the pediatric lung transplant candidate selection. Beat all it’s important to notice that no prospective, randomized studies are conducted so far to support the published guidelines. Overall, timing of referral to a transplant center is analogous in adult and pediatric practice, albeit younger children should ideally be referred early as long waiting times for suitable smaller donor organs are to be expected. The updated ISHLT consensus document includes disease-specific criteria for referral and listing for transplant of the foremost common primary indications for lung transplantation. As CF is that the commonest pathology resulting in pediatric lung transplantation and referral patterns and listing criteria are almost like adults, the consensus recommendations are discussed here in additional detail. At the assessment of each pediatric lung transplant candidate, the kid and family require to be appropriately informed and sufficiently educated. Even a toddler should be willing to plan to the planned transplant operation and to generally consent to the close post-operative long-term follow-up needed. Child and family support is significant and will be implemented before listing for transplantation if not already found out.

Overall, adherence to medical treatment must be evaluated before listing for lung transplantation. Non-adherence may be a leading cause for the event of CLAD and inferior long-term outcome post-transplant, especially in adolescents, a well known features following transplantation across all solid organ types.

As a general rule, contraindications in pediatric lung transplantation are almost like adult practice, but relative contraindications could be different between centers. In CF lung transplant candidates particularly acceptance of listing for lung transplant may differ among transplant programs, counting on CF airway pathogens isolated before transplantation. Nevertheless, all transplant candidates need to be carefully assessed in sight of potential infection risks. Isolation of NTM within the airways of CF patients shouldn’t be considered an absolute contraindication for lung transplantation; however, all NTMs got to be classified first. Just in case of isolation counting on the antibiotic resistance pattern, some centers would consider such circumstance a contraindication for lung transplant. Nevertheless, appropriate treatment strategies must be discussed and implemented with support by the transplant infectious diseases specialist.

Often smaller children wait an extended time on the roll before an appropriate donor organ is allocated, and in such candidates ECLS as a bridge to lung transplantation is to be considered. Children should be fully evaluated and already listed candidates on the transplant roll with rapidly advancing respiratory failure, to stabilize the kid until an appropriate donor organ is allocated. Generally, candidates for ECLS as bridge to transplantation should be in single-organ failure with an honest rehabilitation potential. The recently published consensus document by the ISLHT Pulmonary Council lists contraindication for ECLS as bridge to transplantation like septic shock and multi-organ failure that also are applicable for pediatric candidates. A bigger analysis of pediatric UNOS data on the utilization of ECMO at the time of lung transplantation showed no negative impact on the post-operative death rate.