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Pediatric Lung Transplantation Now Performed Entirely at Morgan Stanley Children's Hospital

(Mar 28, 2008) Children needing a lung transplant can now have all their care--from pre-operative planning, to surgery, to post-operative recovery--provided at Morgan Stanley Children's Hospital. Through the collaboration of NewYork-Presbyterian's adult lung transplant team, pediatric pulmonologists, and multidisciplinary specialists, coupled with the opening of the new Laura Rothenberg Endoscopy and Bronchoscopy Suite, the first pediatric lung transplant to be performed at Morgan Stanley Children's Hospital took place on March 20, 2008. Previously, the operative and immediate post-operative care for pediatric patients needing a lung transplant were provided at NewYork-Presbyterian/Columbia.

The Laura Rothenberg Bronchoscopy/Endoscopy Suite, which opened in 2007, was supported by an anonymous gift and dedicated to the memory of Laura Rothenberg. Ms. Rothenberg received national acclaim for her two-year audio diary for National Public Radio that chronicled her experiences of living with cystic fibrosis. She died in 2003 at the age of age 22.

"Lung transplantation in children is challenging and requires a dedicated program and team to achieve optimal results," says Joshua R. Sonett, MD, Surgical Director of the Lung Transplantation Program at NewYork-Presbyterian/Columbia. The NewYork-Presbyterian Transplant Institute performs over 50 lung transplantations a year, with a one-year survival rate of over 92 percent--one of the highest nationwide.

Many children who require lung transplants suffer from cystic fibrosis, the inherited disease in which thick mucus forms and clogs up the lungs. Others suffer from lung diseases, such as pulmonary fibrosis, or congenital heart diseases, such as Eisenmenger's syndrome, which can also affect the lungs. Although in the past, children with cystic fibrosis generally did not survive their teens, advances in techniques, new drugs for clearing or thinning accumulated mucus, novel antibiotics to prevent lung infections, and other medical innovations are allowing these patients to live fuller lives well into adulthood.

Surgical transplantation is just one part of treating these patients, stresses Dr. Sonett, and the key to a successful transplant program is the ability to provide a wide array of integrated clinical services, from psychiatric counseling to medical management.

NewYork-Presbyterian Hospital has taken a leadership role in perfecting techniques and patient selection criteria for lung transplantation in patients with cystic fibrosis. As a result, the Hospital is home to the largest cystic fibrosis lung transplant program in New York City, which expanded in 2007 to include patients under the age of 18 years. Although current management strategies reasonably control the disease into adulthood in most pediatric patients, lung transplantation may offer extended survival in children with advancing disease who have severe and irreversible airflow obstruction.

"Obviously, the goal is to delay transplant as long as possible, but it is important to have the option of transplantation for any individual with advanced cystic fibrosis," notes Selim Arcasoy, MD, Medical Director, Lung Transplantation Program at NewYork-Presbyterian/Columbia. The expanded program has no age limit, and children will be considered for transplantation as early as necessary.

"Our program has generated very good outcomes data in follow-up that now exceeds five years in cystic fibrosis patients," Dr. Arcasoy reports. "New-York Presbyterian's one-year survival for cystic fibrosis lung transplants has been 96 percent, and the three-year survival is 90 percent. In contrast, the national data from UNOS (United Network for Organ Sharing) is currently reporting one-year survival of 83 percent and three-year survival of 67 percent."

Contributing to the high rates of survival in the NewYork-Presbyterian/Columbia program are the research efforts of Drs. Arcasoy and Sonett. Additionally, the transplant program has been very active in studies of the pathophysiology of graft rejection, including early detection of genetic signals of an impending rejection episode. Efforts to provide sufficient immunosuppression to suppress rejection episodes while minimizing the complications of immunosuppressive agents are critical to extending graft and patient survival.

Because of the challenges of transplantation for patients, Dr. Arcasoy emphasizes the importance of early referral of patients with advancing cystic fibrosis, whether they are adults or children. "It is best if we can consult with patients long before lung transplantation is necessary," he says. "It not only provides time to perform tests on a timely basis, but also to prepare the patient both physically and psychologically for transplant if it becomes necessary.

"Fortunately, there is a limited need for lung transplantation in pediatric cystic fibrosis patients due to the progress in medical management," Dr. Arcasoy adds. "However, there are cases where this is the best option for extending life, and we have been encouraged that outcomes in younger patients appear to be as good as those observed in adults."

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