The history of lung transplantation is inexorably linked to the University of Toronto in the 1980s and the surgeons and medical team there at that time. The first lung transplant was performed in Mississippi in 1967, and patients with end-stage lung disease started receiving successful heart-lung transplants at Stanford and Pittsburgh in the early 1980s, but Toronto developed the procedures of single and double lung transplants as they're done today. The names of Drs. Joel Cooper, Alec Patterson, and Griff Pearson are mentioned most as the pioneers, but another member of this team, Dr. Thomas Todd, has documented the history of lung transplantation firsthand in his book Breathless: A Transplant Surgeon's Journal.
Thursday, April 28, 2011
Book Review: Breathless
Posted by Manu Varma at 5:42 PM 0 comments
Monday, April 25, 2011
Pediatric vs. Adult Transplants
Pediatric transplantation has been a focus of this blog, mainly because I'm especially interested in the stories and unique issues of children who need organ transplants. Many aspects of transplantation are similar between children and adults, but there are some key differences.
Kidney
Percent pediatric: 5%
Indications in adults
- Diabetes
- Hypertension
- Glomerulonephritis
Indications in children
- Renal dysplasia
- Posterior urethral valve
- Focal segmental glomerulosclerosis
Differences in surgical approach
In adults, a kidney transplant is placed in the pelvis and attached to the blood vessels going to the leg (usually the external iliac vessels). For children between 10 kg and 20 kg, the kidney is placed in the abdomen and attached to the main blood vessels in the body (aorta and inferior vena cava). For children under 10 kg, dialysis is generally preferred to a kidney transplant. Young children actually do better with adult kidneys rather than kidneys from other children.
Liver
Percent pediatric: 12%
Indications in adults
- Hepatitis C infection
- Alcoholic cirrhosis
- Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC)
Indications in children
- Biliary atresia
- Metabolic diseases
- Fulminant hepatic failure
Differences in surgical approach
Children can often receive the left lateral lobe of an adult liver, either from a deceased donor (split liver transplant) or a living donor (living donor liver transplant). The left lateral lobe is relatively easier to identify and divide than the right lateral lobe (relatively easier--both are very challenging operations!), and children were the first recipients of partial liver transplants. Children can also receive a whole organ liver transplant from another child.
Heart
Percent pediatric: 13%
Indications in adults
- Ischemic cardiomyopathy
- Idiopathic cardiomyopathy
Indications in children
- Cardiomyopathy (particularly dilated cardiomyopathy)
- Congenital heart disease (particularly hypoplastic left heart syndrome)
Differences in surgical approach
Patients receiving heart transplants for congenital heart diseases (usually children, sometimes adults) often need a longer segment of donor aorta with the transplant. The native aorta may have been part of the original problem and reconstructed as a "neoaorta" as part of the Norwood operation, so the aorta may also need replaced at the time the heart needs replaced.
Lung
Percent pediatric: 4%
Indications in adults
- COPD (chronic obstructive pulmonary disease)
- Cystic fibrosis
- Idiopathic pulmonary fibrosis
Indications in children
- Cystic fibrosis
- Pulmonary hypertension
- Congenital lung malformations
Differences in surgical approach
The younger and smaller a lung transplant patient is, the more likely they are to receive a double lung transplant and need cardiopulmonary (heart-lung) bypass for the operation. However, the operation is generally the same in children and adults.
Small bowel
Percent pediatric: 57%
Indications in adults
- Mesenteric ischemia
- Crohn's disease
- Intestinal tumors (desmoid and carcinoid)
Indications in children
- Gastroschisis
- Necrotizing enterocolitis (NEC)
- Malrotation and midgut volvulus
Differences in surgical approach
One of the challenges with intestinal transplants is that the donor usually needs to be of a smaller body size than the recipient. Since children needing intestinal transplants are small already (because of their intestinal failure and...because they're children), finding a smaller donor than the recipient can be especially challenging.
Read More...Posted by Manu Varma at 1:12 PM 10 comments