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67 - Heart and lung transplantation

from Part VII - Transplantation

Published online by Cambridge University Press:  08 January 2010

By
Thomas Spray  and
Stephanie M. P. Fuller
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Thomas Spray
Affiliation:
Heart, Lung and Heart Transplant Services, Children's Hospital of Philadelphia, PA, USA
Stephanie M. P. Fuller
Affiliation:
Heart, Lung and Heart Transplant Services, Children's Hospital of Philadelphia, PA, USA
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Introduction

Thoracic organ transplantation is an important treatment option in children with acquired or congenital cardiopulmonary disease. In recent years, there has been considerable improvement in early outcomes following thoracic organ transplantation in children and 1-year survival is similar now to that in adults. Approximately 250 pediatric heart transplants and 60 lung transplants are performed annually in the United States. Thoracic organ transplantation in neonates and infants has been limited by donor availability, and the number of thoracic organ transplants performed each year in children has plateaued. Complications such as acute and chronic rejection, graft coronary artery disease (CAD) or bronchiolitis obliterans, as well as those of immunosuppression, pose serious threats to the long-term success of thoracic organ transplantation in children. Despite these potential impediments, life expectancy and quality of life for patients following transplantation exceed that for patients with end-stage cardiopulmonary disease who are managed medically. This chapter focuses on the clinical aspects of heart and lung transplantation in infants and children including indications, preoperative evaluation, postoperative course and management, complications and long-term outcomes.

Indications

Heart transplantation

As published by the Registry for the International Society for Heart and Lung Transplantation (ISHLT) in the Seventh Official Report in May 2004, the number of pediatric heart transplants has remained relatively constant over the last 10 years (Fig. 67.1). The most common indication for heart transplantation in the neonatal population remains complex congenital heart disease for which no reasonable corrective or palliative surgical therapy is available.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 897 - 912
Publisher: Cambridge University Press
Print publication year: 2006

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