On the horizon: neonatal lung transplantation.

There are several congenital lung lesions that result in severe pulmonary hypoplasia and neonatal death. These malformations include congenital diaphragmatic hernia (CDH), oligohydramnios induced pulmonary hypoplasia, and congenital cystic adenomatoid malformation of the lung. Severely affected newborns are not salvageable by current surgical techniques or medical treatment, although one new experimental approach is prenatal surgical intervention in highly selected cases.1-3 In older children respiratory failure is the final common pathway in severe cases of bronchopulmonary dysplasia, cystic fibrosis, and primary pulmonary hypertension. One potential treatment for all of these fatal problems is lung transplantation. plants are recorded in the International Lung Transplant Registry at Washington University and the indications included severe bronchopulmonary dysplasia, cystic fibrosis, and refractory pulmonary hypertension. The youngest recipient was 16 months of age, and the overall actuarial one year survival was 60%. However, paediatric lung transplantation is hampered by the paucity of potential donors and a lack of understanding of many physiological responses to transplantation in immature recipients. Cadaveric or living related donation of a reduced size lung (pulmonary lobe or segment) may help solve the donor shortage problem for lung transplantation in infants and children. It is essential that experimental studies be crafted to address some of the biological questions.