Indications for lung transplantation

Pediatric lung transplant is nowadays an accepted therapy in well-selected children with end-stage pulmonary disease, offering prolonged overall survival and better quality of life. Over 100 pediatric lung transplants are reported to the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry annually. In order to maximize posttransplant survival in children, careful candidate selection is absolutely crucial. Primary diagnostic indications for lung transplantation in children is cystic fibrosis (CF) pulmonary disease overall, followed by pulmonary hypertension and interstitial lung disease and obliterative bronchiolitis. However, there is a varying distribution of diagnostic indications depending on children’s ages. In younger children, surfactant protein deficiencies, congenital heart disease, and idiopathic pulmonary arterial hypertension are the commonest diagnoses, respectively. In older children, CF is the most frequent indication for lung transplantation. Further, marked regional differences exist worldwide regarding indications, reflecting diverse referral patterns and differences in disease management. In North America, half of the children undergoing lung transplantation have CF; in Europe, over two-thirds of children suffer with CF. Today, the ISHLT has international consensus guidelines in place, including general guidance on the selection of pediatric candidates and disease-specifics on referral and timing for listing for lung transplantatio