Pediatric lung transplantation.

As the first decade of successful clinical lung transplantation draws to a close, the number of patients who are able to benefit from it continues to increase. Pulmonary transplantation in the pediatric age group is possible for an expanding range of diagnoses currently known to cause end-stage lung disease. However, more experience will be required before the answers to a number of clinical problems are found. The following issues are particularly pertinent to the pediatric age group: (1) Controversy still exists as to the most appropriate operation for certain clinical situations (eg, single- or double-lung transplants for primary pulmonary hypertension, or secondary pulmonary hypertension after cardiac repair). These decisions are made based on physiological considerations as well as donor availability and the need to use the donor pool as efficiently as possible. (2) Technical controversies in pediatric lung transplantation include the optimal technique for performing the bronchial anastomosis in a manner that will permit healing without stenosis of the airway. Cardiopulmonary bypass is required for most lung transplants in children. (3) OB continues to plague the long-term results of lung transplantation and may be more common in the pediatric age group. OB may respond to increased immunosuppression. (4) Lobar transplantation in children may be an effective method of increasing the availability of donors. More experience will be necessary to further refine this technique.