[ISPHLT-SY4-1] Management of pediatric lung transplant recipients and post-transplant outcome
Lung transplantation is the ultimate therapy option for infants, children, and adolescents with progressive advanced lung disease. Recently, outcomes after pediatric lung transplantation have improved, survival is nowadays now comparable to adult lung transplantation. In order to achieve maximal post-transplant outcomes, an interdisciplinary team effort is required. In the early post-operative period, intensive care physicians play a key role together with transplant surgeons and transplant pulmonologists. Post-transplant, immunosuppression is imperative for prevention of lung allograft rejection, but evidence-based data on immunosuppression are lacking. Drug-related side effects are very frequent; thus, close therapeutic drug monitoring is critical, an individually tailored patient approach is favorable rather than an one fits all attitude. In the first year post-transplant, infectious complications are the leading causes of morbidity and mortality. In general, community acquired viral infections in children are frequent following lung transplantation. In the long-term, chronic lung allograft dysfunction (CLAD) is the leading cause of morbidity and mortality, it remains the Achilles' heel of pediatric lung transplantation, Therapy options for CLAD are unfortunately still limited, management is based on extrapolated data in adult lung transplantation. The last option for worsening CLAD would be consideration for lung re-transplantation; however, numbers of pediatric lung re-transplants are very small, and its success depends highly on the optimal selection of the most suitable re-transplant candidate, ideally a non-invasively ventilated child with a good potential for rehabilitation well beyond the first year post primary lung transplantation.