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Organ Transplantation
Lung Transplantation
The leading indications for pediatric lung transplantation are:
- Cystic fibrosis
- Bronchiolitis obliterans
- Focal nodular hyperplasia
- Inadequate lung development
- Interstitial lung disease
- Primary pulmonary hypertension
- Pulmonary vascular diseases
- Surfactant protein deficiencies
NewYork-Presbyterian Morgan Stanley Children's Hospital has major programs in pediatric pulmonary vascular disease, pediatric congenital heart problems, and pediatric cystic fibrosis. These programs collaborate closely with our lung transplant specialists.
NewYork-Presbyterian Hospital has taken a leadership role in perfecting techniques and patient selection criteria for lung transplantation in patients with cystic fibrosis (CF). As a result, the Hospital is home to the largest adult CF lung transplant program in New York City, and has now expanded the program 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 pediatric patients with advancing disease who have severe and irreversible airflow obstruction. As part of the expanded program, there is no age limit, and children will be considered for transplantation as early as necessary.
Pediatric patients who are considered for transplant typically have irreversible disease that has rendered them dependent on supplemental oxygen. Other signs of advancing disease, such as frequent exacerbations, high blood levels of carbon dioxide, and pulmonary hypertension, are also usually present. CF is the reason for transplant in approximately 20 percent of the lung transplants performed at NewYork-Presbyterian/Columbia. Outcomes to date have been similar in children and adults.
The one-year survival for lung transplants overall 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.
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. Their efforts to provide sufficient immunosuppression to prevent rejection episodes while minimizing the complications of these agents are critical to extending graft and patient survival.
Because of the challenges of transplantation for patients, early referral of patients with advancing CF is critical, whether they are adults or children. This 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.
