Lung and heart lung transplantation

Lung and heart-lung transplantation has become an accepted therapeutic option for children with end-stage pulmonary parenchymal and vascular disease. In the past 25 years, nearly 1,800 lung and 700 heart-lung procedures have been reported worldwide in children. As experience with bilateral lung transplantation has grown, indications for heart-lung transplant have diminished. The latter procedure now makes up less than 10 % of the combined total each year. In spite of steady improvements in survival, mostly related to better early outcomes, long-term survival rates for pediatric lung and heart-lung recipients remain worse than those in other solid organ transplants. As the lung is continually exposed to the environment through the airway, it is thought that exposure to infectious agents and toxins is responsible for higher rates of infection and immunologic complications such as bronchiolitis obliterans, which is the major cause of long-term morbidity and mortality. Ongoing research related to prevention and treatment of bronchiolitis obliterans and other posttransplant complications is needed to improve quality of life and survival in this population of patients.