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INTRODUCTION

The first lung transplant was performed in 1963, but it was not until 2 decades later that Cooper and Patterson moved the field forward to practical success with modifications in surgical technique and the availability of cyclosporine. The first successful single-lung transplant was performed in the 1980s, the first successful bilateral lung transplant in 1988, and the first successful pediatric transplant soon thereafter.

In the 1990s, the number of lung transplants performed in both adults and children increased as heart-lung transplant volumes declined. However, as the number of lung transplants occurring in adults has increased year by year since the year 2000, there has been a plateau in the number of pediatric transplants. During the last 10 years, approximately 100 to 120 transplants per year in recipients younger than 18 years of age have been reported worldwide compared to an increase from 2000 to nearly 4000 transplants in adults over the same period. Although pediatric numbers remain small, lung transplantation in children has become an accepted treatment modality for selected infants, children, and adolescents with end-stage lung disease in the few centers where this therapy is offered.

EPIDEMIOLOGY

In the United States, as of 2016, only 9 free-standing pediatric lung transplant centers exist. Only 4 of these centers consistently transplant 4 or more children on an annual basis. There are several European centers, most of which are adult-oriented with low-volume pediatric clinical activity. Infant and young child lung transplantation is far less common in Europe than in North America (Fig. 509-1). The reasons for the rarity of pediatric lung transplant centers around the world likely relate to the intensity of resources required to maintain clinical activity and expertise. Other contributory factors include better management of conditions such as cystic fibrosis, thus reducing the need for lung transplantation, and shortage of donors. The lung transplant team includes 1 or more dedicated pulmonologists, transplant surgeons, nurse coordinators, and a multidisciplinary team, which requires a heavy practical commitment from individuals, pediatric and surgical departments, and hospital administrations.

Figure 509-1

Recipient age distribution for pediatric lung transplantation based on country of transplantation. (Reproduced with permission from Goldfarb SB, Benden C, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Eighteenth Official Pediatric Lung and Heart-Lung Transplantation Report – 2015: focus theme: early graft failure, J Heart Lung Transplant. 2015 Oct;34(10):1255-1263.)

The much higher number of pediatric heart and liver transplants suggests that the number of pediatric organ donors is adequate. Lungs are the organ most likely to be judged unsuitable for transplantation due to chest trauma, pneumonia, or atelectasis. More aggressive donor management might increase the donor lung numbers. Furthermore, it is conceivable, especially related to cystic fibrosis, that improved medical management has decreased the number of potential recipients with ...

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