Benden Christian
Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
J Thorac Dis. 2017 Aug;9(8):2675-2683. doi: 10.21037/jtd.2017.07.84.
Pediatric lung transplantation has been undertaken since the 1980s, and it is today considered an accepted therapy option in carefully selected children with end-stage pulmonary diseases, providing carefully selected children a net survival benefit and improved health-related quality of life. Nowadays, >100 pediatric lung transplants are done worldwide every year. Here, specific pediatric aspects of lung transplantation are reviewed such as the surgical challenge, effects of immunosuppression on the developing pediatric immune system, and typical infections of childhood, as it is vital to comprehend that children undergoing lung transplants present a real challenge as children are not 'just small adults'. Further, an update on the management of the pediatric lung transplant patient is provided in this review, and future challenges outlined. Indications for lung transplantation in children are different compared to adults, the most common being cystic fibrosis (CF). However, the primary diagnoses leading to pediatric lung transplantation vary considerably by age group. Furthermore, there are regional differences regarding the primary indication for lung transplantation in children. Overall, early referral, careful patient selection and appropriate timing of listing are crucial to achieve real survival benefit. Although allograft function is to be preserved, immunosuppressant-related side effects are common in children post-transplantation. Strategies need to be put into practice to reduce drug-related side effects through careful therapeutic drug monitoring and lowering of target levels of immunosuppression, to avoid acute-reversible and chronic-irreversible renal damage. Instead of a "one fits all approach", tailored immunosuppression and a personalized therapy is to be advocated, particularly in children. Further, infectious complications are a common in children of all ages, accounting for almost 50% of death in the first year post-transplantation. However, chronic lung allograft dysfunction (CLAD) remains the major obstacle for improved long-term survival.
自20世纪80年代起就已开展小儿肺移植，如今它被视为精心挑选的终末期肺病患儿可接受的治疗选择，能为这些患儿带来净生存获益并改善与健康相关的生活质量。如今，全球每年完成100多例小儿肺移植手术。在此，对小儿肺移植的特定方面进行综述，如手术挑战、免疫抑制对小儿发育中免疫系统的影响以及儿童期典型感染，因为必须认识到接受肺移植的儿童面临着真正的挑战，因为儿童并非“仅仅是小成年人”。此外，本综述还提供了小儿肺移植患者管理的最新情况，并概述了未来的挑战。儿童肺移植的适应证与成人不同，最常见的是囊性纤维化（CF）。然而，导致小儿肺移植的主要诊断因年龄组而异。此外，儿童肺移植的主要适应证存在地区差异。总体而言，早期转诊、仔细的患者选择和合适的列入名单时机对于实现真正的生存获益至关重要。尽管要保留同种异体肺功能，但免疫抑制剂相关的副作用在小儿移植后很常见。需要通过仔细的治疗药物监测和降低免疫抑制目标水平来实施策略，以减少药物相关副作用，避免急性可逆性和慢性不可逆性肾损伤。应提倡采用量身定制的免疫抑制和个性化治疗，而不是“一刀切”的方法，尤其是在儿童中。此外，感染并发症在各年龄段儿童中都很常见，占移植后第一年死亡人数的近50%。然而，慢性肺同种异体移植功能障碍（CLAD）仍然是提高长期生存率的主要障碍。
