Pediatrics in Review
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 Vol. 28 No. 12, December 2007
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(Pediatrics in Review. 2007;28:439-453.)
© 2007 American Academy of Pediatrics

What's New in Childhood Organ Transplantation


Debra Sudan, MD*
Emile A. Bacha, MD{dagger}
Eunice John, MD{ddagger}
Amelia Bartholomew, MD§
 * Professor of Surgery; Director, Living Donor and Intestinal Rehabilitation Programs, University of Nebraska Medical Center, Omaha, Neb
{dagger} Associate Professor of Surgery; Senior Associate, Department of Cardiac Surgery, Harvard Medical School, Children's Hospital Boston, Boston, Mass
{ddagger} Professor and Director, Pediatric Nephrology, University of Illinois at Chicago Medical Center, Chicago, Ill
§ Associate Professor, Transplantation and Molecular Genetics, University of Illinois at Chicago Medical Center, Chicago, Ill

The first 300 words of the full text of this article appear below.


   Learning Objectives
 

  1. Describe the indications, immunosuppression therapy, outcomes, potential complications, and long-term issues of kidney transplantation.
  2. Describe the indications, surgical techniques, immunosuppressive therapy, and outcomes of liver transplantation.
  3. Describe the indications, surgical techniques, immunosuppressive therapy, potential complications, and prognosis of intestinal transplantation.
  4. Describe the indications, surgical techniques, required mechanical support, immunosuppressive therapy, and outcomes of heart transplantation.
  5. Describe the indications, immunosuppressive therapy, and outcomes of lung transplantation.
  6. Delineate the role of the primary care physician in organ transplantation.


   Introduction
 
Transplantation remains the most effective treatment for children who have end-organ failure. In this review, we summarize the current issues facing children and their treating physicians following transplantation of whole organs. Although recipients of allogeneic bone marrow can follow a similar clinical course as organ recipients, bone marrow transplantation as a therapy has additional unique posttransplant features that are not covered in this article.

Regardless of transplant type, common themes emerge. Children differ from adults in their immune responses, in the way they metabolize many drugs, and in their susceptibility to many of the adverse effects of transplantation and immunosuppression. Drug regimens based on induction immunotherapy with interleukin-2 receptor antagonists or anti-lymphocyte antibody coupled with tacrolimus-based long-term immunosuppression have increased in prevalence. Long-term exposure to immunosuppressive medications, however, has led to increased drug-related morbidities. Hyperlipidemia, hypertension, cardiovascular disease, malignancy, and diabetes mellitus have emerged as significant concerns. Nonadherence to immunosuppressive regimens, particularly among adolescents, contributes to increased graft failure.

Despite these obstacles, posttransplant pediatric patient and graft survival have been improving steadily. Nationwide data indicate that patient and graft survival rates are equivalent to or better than adult survival rates. Successful delivery of care for the long-term well-being of these patients demands communication between the patient and a complex of many physicians, from the earliest encounters with general pediatricians to more specialized care with . . . [Full Text of this Article]






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