The Pediatric Pulmonologist and the Infant or Child Before Lung Transplantation

Pretransplant Evaluation and Care of the Potential Pediatric Lung Recipient
  • Anjani K. Ravindra
  • Jonathan E. Spahr
  • Geoffrey Kurland
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


While pediatric lung transplantation began in 1987, survival rates have remained stagnant. Therefore, the role of pretransplant evaluation and care has become more crucial in identifying appropriate transplantation candidates and affording their best chance of success. There are a variety of indications for pediatric lung transplantation that vary in prevalence based on age; specific indications can at times direct pretransplant care. Factors to consider when evaluating a candidate include a clear diagnosis that warrants transplantation, a support system for posttransplantation care, and access to a lung transplantation center. A number of previously absolute contraindications have now become relative contraindications due to medical advances; however, significantly advanced organ dysfunction remains an absolute contraindication. Referral for transplantation is based on a “transplantation window” or a time where survival benefit of transplantation is high. This “window” is dynamic, as changes in a patient’s clinical status or new infections can rapidly alter a patient’s acceptability as a recipient. To better assess timing of referral, the evaluation process includes blood work, cultures, lung function testing, as well as assessment of non-pulmonary systems by specialists as well as psychosocial evaluation. The lung allocation score (LAS) was developed in 2005 to help improve waiting time for organs and weighs both waitlist mortality and survival probability posttransplantation. Reevaluation thus must be recurrent to adjust a patient’s LAS score accordingly. Overall, the quality of life pretransplantation has to be weighed against the predicted outcome posttransplantation.


Children Transplantation Immunosuppression Evaluation Lung Cystic fibrosis Allocation Recipient Referral Survival benefit Waiting period 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Anjani K. Ravindra
    • 1
  • Jonathan E. Spahr
    • 2
  • Geoffrey Kurland
    • 1
  1. 1.Division of Pediatric Pulmonology, Allergy, and Immunology, Department of PediatricsChildren’s Hospital of PittsburghPittsburghUSA
  2. 2.Division of Pediatric PulmonologyGeisinger Medical CenterDanvilleUSA

Section editors and affiliations

  • J Jeffrey Malatack
    • 1
  1. 1.Diagnostic Referral DivisionNemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

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