Chapter 79 Transplantation
Organ
PATHOPHYSIOLOGY
Tremendous strides have been made in pediatric transplantation in the last decade. Organ transplantation is an acceptable form of treatment for end-stage organ failure. Advances in immunosuppression, improvements in surgical techniques, and experience in postoperative management have contributed to the improved results. Kidney, liver, and heart transplantations have become routine, and lung and small bowel transplantations are increasing in numbers. Primary diseases that can lead to the need for renal transplantation include acquired diseases such as chronic glomerulonephritis, lupus erythematosus, pyelonephritis, hemolytic-uremic syndrome, and bilateral Wilms’ tumor. It is also the treatment for congenital conditions such as polycystic disease, obstructive uropathy, cystinosis, and Alport syndrome. The major indications for liver transplantation include biliary atresia, alpha1-antitrypsin deficiency, tyrosinemia, and posthepatic cirrhosis. Indications for cardiac transplantation include cardiomyopathy, hypoplastic left heart syndrome, and other lethal, complex, congenital heart anomalies.
The major problem associated with transplantation is rejection. Rejection can result from any of a variety of causes: cellular and/or humoral immune response, infection, and noncompliance with treatment regimen. Other causes of graft failure include technical failure, infection, and medication toxicity.
The survival rates have improved significantly in recent years and range from 85% to 95% at 1 year after transplantation. Factors restricting transplantation currently are the limited availability of organs and the need for lifelong immunosuppression. Growth may be delayed, but pubertal development proceeds normally after successful transplantation.
