A pediatric lung transplant is a complex surgical procedure performed to replace one or both diseased lungs in children with healthy donor lungs.
This life-saving operation is generally considered for children with severe lung conditions that have not responded to other treatments.
Understanding the lung transplant process can help you prepare and know what to expect.
Pediatric lung surgeons at WashU Medicine
Pediatric lung surgeons at WashU Medicine see patients at St. Louis Children’s Hospital, one of the top hospitals in the nation for pediatric care and the top hospital in St. Louis and Missouri.
What is a pediatric lung transplant?
A pediatric lung transplant involves surgically removing one or both diseased lungs from a child and replacing them with healthy lungs from a deceased donor. This procedure aims to improve the child’s lung function and overall quality of life.
Why does a child need a lung transplant?
There are several conditions and problems that might lead to a child needing a lung transplant. Sometimes children are born with genetic conditions that can cause problems with their lungs. In many cases, doctors will try to use other, less complex treatments before a lung transplant. When other treatments don’t work, or when a child’s lungs are too damaged, lung transplant may be the best available option.
Severe lung conditions
- Cystic fibrosis: Genetic disorder causing thick mucus buildup in the lungs, leading to severe respiratory issues.
- Pulmonary hypertension: High blood pressure in the lungs’ blood vessels, causing heart and lung complications.
- Bronchopulmonary dysplasia (BPD): Chronic lung disease affecting infants, often due to premature birth and extended ventilator use.
- Interstitial lung diseases: Group of disorders causing scarring of lung tissue, leading to severe respiratory impairment.
Other considerations
- Failure of medical therapy: Conditions that have not responded to maximal medical treatment and are causing significant morbidity.
- Quality of life: Severe lung disease affecting the child’s ability to perform daily activities and significantly impacting quality of life.
Did you know?
The country’s first freestanding pediatric lung transplant program was established by WashU Medicine pediatric cardiothoracic surgeons at St. Louis Children’s Hospital in 1990.
Since then, the program has performed hundreds of pediatric lung and heart-lung transplants, making it one of the most active pediatric lung transplant programs in the world.
Criteria for pediatric lung transplant
Clinical assessment
- Severity of lung disease: Candidates typically have advanced lung disease with severely impaired lung function.
- Overall health: Assessment of the child’s overall health to ensure they can withstand the surgery and post-operative recovery.
Psychosocial evaluation
- Family support: Evaluation of the family’s ability to support the child through the transplant process and post-operative care.
- Mental and emotional readiness: Assessment of the child’s and family’s mental and emotional readiness for the challenges associated with the transplant.
Additional criteria
- Adherence to medical regimen: Commitment to adhering to medical treatment plans before and after the transplant.
- Absence of contraindications: Evaluation to ensure there are no contraindications, such as severe infections or other major organ failures.
Preparation for pediatric lung transplant
Preoperative evaluation
- Comprehensive assessment: Detailed medical and psychosocial evaluation, including imaging studies (X-ray, CT scan), pulmonary function tests, blood tests, and heart function tests (echocardiogram).
- Education and counseling: Preoperative education for the child and family about the transplant process, expectations, and post-operative care.
- Organ matching: Coordination with organ transplant networks to find a suitable donor match based on blood type, body size, and lung condition.
Lifestyle modifications
- Infection prevention: Measures to reduce the risk of infections, including vaccinations and hygiene practices.
- Nutritional support: Nutritional evaluations and interventions to ensure the child is in optimal nutritional status for surgery.
The surgical process
Before surgery
- Anesthesia: General anesthesia is administered to ensure the child is asleep and pain-free during the procedure.
- Preparation: The surgical team prepares the operating area and ensures all required medical equipment is ready.
Surgical steps
- Incision: An incision is made in the chest to access the lungs.
- Removal of diseased lung(s): The surgeon carefully removes the diseased lung or lungs.
- Placement of donor lung(s): The healthy donor lung or lungs are positioned and connected to the child’s airways and blood vessels.
- Closure: The incision is closed, and the child is moved to the intensive care unit (ICU) for close monitoring.
The procedure typically takes several hours, depending on the complexity and whether one or both lungs are being transplanted.
Members of the care team typically provide the family with updates throughout the process.
Postoperative care and recovery
Immediate postoperative care
- Intensive care unit (ICU): The child is monitored closely in the ICU for several days to manage pain, prevent infections, and ensure the new lung(s) are functioning correctly.
- Ventilator support: Temporary ventilator support may be necessary to help the child breathe until they can breathe independently.
Hospital stay
The length of the hospital stay varies but typically ranges from weeks to a few months, depending on recovery progress and any complications.
At-home care
- Medications: Lifelong immunosuppressive medications to prevent organ rejection, along with antibiotics, antivirals, and other medications to prevent infections and manage health.
- Lifestyle modifications: Continued focus on infection prevention, nutritional support, and adherence to medical regimens.
Follow-up care
- Regular appointments: Frequent follow-up visits to monitor lung function, manage medications, and address any concerns.
- Pulmonary rehabilitation: Physical therapy to strengthen respiratory muscles and improve lung function.
Potential risks and complications
Common risks
- Infection: Risk of bacterial, viral, or fungal infections due to immunosuppressive therapy.
- Bleeding: Risk of bleeding during and after surgery.
Specific complications
- Organ rejection: The body may reject the new lung(s), requiring adjustments in immunosuppressive medications or additional treatments.
- Bronchiolitis obliterans syndrome (BOS): Chronic rejection leading to scarring and narrowing of the airways.
Rare complications
- Blood clots: Risk of developing blood clots in the lungs or other areas, requiring anticoagulant therapy.
- Adverse reactions to medications: Side effects from immunosuppressive and supportive medications.
Long-term considerations
- Ongoing monitoring: Lifelong monitoring and follow-up care to ensure the health and function of the transplanted lungs.
Pediatric lung transplant is a complex but life-saving procedure for children with severe lung diseases. Understanding the criteria for candidacy, the preparation process, the surgical procedure, and post-operative care is crucial for the best possible outcomes. If you are considering a pediatric lung transplant, consult with a specialized medical team to explore this option and determine the best approach for your child’s specific condition.
