招請講演V　
Current status of pediatric lung transplantation
Chief, Clinical Transplantation Section, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
Nancy D. Bridges
Fewer than 100 children per year undergo lung transplantation; the majority of these procedures occur in the U.S., where 17% of pediatric lung recipients have received their lungs from a living donor. Whereas improvements in technical aspects of the surgery and of perioperative care have led to excellent early outcomes, the medium and long term results remain disappointing, with a survival half time of only 6 to 7 years among those who survive the operation. The prevalence of obliterative bronchiolitis among those surviving to 5 years is 50%.
This review of the current status of pediatric lung transplantation will focus on the issues of greatest medical and ethical concern in pediatric lung transplantation. These include:
  1. candidate selection and survival benefit
  2. the use of lobes from living donors
  3. post-transplant monitoring
  4. growth of transplanted lungs
  5. the impact of viral illness, and approaches to prophylaxis and treatment of viral infection
  6. the use and impact of newer immunosuppressive strategies
  7. post-transplant lymphoproliferative disease
  8. obliterative bronchiolitis
  9. functional status and health-related quality of life
Finally, a review of new directions in clinical research in organ transplantation, and their relevance to and potential impact on pediatric lung transplant recipients, will be presented.


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