Even with a recent increase in the number of donors, a remarkable donor shortage remains in pediatric lung transplantation. Moreover, lung transplantation in pediatrics is still challenging in its perioperative management.
In preoperative time, it is difficult to determine an exact normal range for the pediatric population. In anesthetic induction, residual respiratory function must be carefully considered. In severe cases, extra corporeal support should be prepared. Because hemilateral lung transplantation is common in children, their induction is normally safe. Prevention of hyperinflation associated with permissive hypercapnia must be considered. Sometimes nitric oxide is useful to control pulmonary hypertension and severe hypoxemia. It normally takes over 30 minutes to wean from a cardiopulmonary bypass for the prevention of ischemia-reperfusion injury. At weaning time, we always use nitric oxide.
After operation, primary graft dysfunction, anastomosis leakage, acute rejection, and infectious complications must be considered. We try to wean mechanical ventilation as soon as possible. It normally takes 2-3 days on average. Unnecessary hyperinflation should be avoided. In some cases, vasoactive drugs such as milrinone were used.
There are huge variations in patients' conditions and underlying diseases. We must pay special attention to patient status in each case. Bronchiolitis obliterans and primary pulmonary hypertension are the most common underlying diseases, and special care is necessary for these types of recipients.