Pediatric Lung Transplantation: Perspectives for the Pathologist

2008 ◽  
Vol 11 (2) ◽  
pp. 85-105 ◽  
Author(s):  
Megan K. Dishop ◽  
George B. Mallory ◽  
Frances V. White
Keyword(s):  
Lung Transplantation ◽  
Pediatric Population ◽  
Adult Population ◽  
Bronchiolitis Obliterans Syndrome ◽  
Pulmonary Vascular Disease ◽  
Pathologic Evaluation ◽  
Routine Surveillance ◽  
Pediatric Pathologist ◽  
Future Challenges ◽  
Cellular Rejection

Lung transplantation offers life-saving and life-extending treatment for children and adolescents with congenital and acquired forms of pulmonary and pulmonary vascular disease, for whom medical therapy is ineffective or insufficient for sustained response. This review summarizes the pathology related to lung transplantation for the practicing pediatric pathologist and also highlights aspects of lung transplantation unique to the pediatric population. Clinical issues related to availability of organs, candidate eligibility, surgical technique, and postoperative monitoring are discussed. Pathologic evaluation of routine surveillance transbronchial biopsies requires attention to acute cellular rejection, opportunistic infection, and other forms of acute and resolving lung injury. These findings are correlated in some cases with endobronchial biopsies and bronchoalveolar lavage as adjunctive tools in surveillance. Open or thoracoscopic biopsies also have diagnostic utility in cases with acute or chronic graft deterioration of uncertain etiology. Future challenges in pediatric lung transplantation are similar to those in the adult population, with continued efforts focused on prolonging graft survival, prevention of bronchiolitis obliterans syndrome due to chronic cellular rejection, and evaluation of humoral rejection.

Rescue alemtuzumab for refractory acute cellular rejection and bronchiolitis obliterans syndrome after lung transplantation

2017 ◽  
Vol 31 (4) ◽  
pp. e12899 ◽  
Author(s):  
Christopher R. Ensor ◽  
Lindsey C. Rihtarchik ◽  
Matthew R. Morrell ◽  
J. W. Awori Hayanga ◽  
Alicia B. Lichvar ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Bronchiolitis Obliterans ◽  
Bronchiolitis Obliterans Syndrome ◽  
Acute Cellular Rejection ◽  
Cellular Rejection

scholarly journals Histopathologic Analysis in Sudden Infant and Child Deaths

2018 ◽  
Vol 8 (3) ◽  
pp. 492-538
Author(s):  
Colleen D’Arcy ◽  
Lili-Naz Hazrati ◽  
David A. Chiasson
Keyword(s):  
Pediatric Population ◽  
Adult Population ◽  
Sudden Infant ◽  
Histopathological Analysis ◽  
Forensic Pathologist ◽  
Collaborative Relationship ◽  
Unexpected Death ◽  
Child Deaths ◽  
Pediatric Pathologist ◽  
Histopathologic Analysis

The forensic pathologist responsible for sudden unexpected death (SUD) investigation in the pediatric setting faces many challenges. It usually takes many years to obtain reasonable experience and exposure to the wide variety of diseases that may present as SUD in a pediatric context, and to appreciate the differences in the etiology and clinical context between the pediatric and adult SUD setting. In pediatric SUD, it is necessary to conduct a systematic, pediatric-focused autopsy investigation including extensive histopathological assessment and ancillary testing. Postmortem histologic findings in the context of SUD in the pediatric population are often subtle and distinctly different from those seen in the adult population. The pathologist must have an understanding of both developmental and pathological processes in order to correctly interpret the findings during a pediatric autopsy. A system-based, histopathology-focused review of common entities, normal variants, and incidental findings that can prove challenging will be discussed. For the forensic pathologist tasked with pediatric SUD autopsies, development of a strong collaborative relationship with a pediatric pathologist and/or neuropathologist to assist with histopathological analysis is strongly endorsed.

scholarly journals Heart and lung transplantation in pulmonary arterial hypertension related to congenital heart disease: an unusual indication

2020 ◽  
Vol 4 (S1) ◽  
Author(s):  
Rosaria Barracano ◽  
Heba Nashat ◽  
Andrew Constantine ◽  
Konstantinos Dimopoulos
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Lung Transplantation ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pulmonary Vascular Disease ◽  
Eisenmenger Syndrome ◽  
Pulmonary Arterial ◽  
Recurrent Haemoptysis

Abstract Background Eisenmenger syndrome is a multisystem disorder, characterised by a significant cardiac defect, severe pulmonary hypertension and long-standing cyanosis. Despite the availability of pulmonary hypertension therapies and improved supportive care in specialist centres, Eisenmenger patients are still faced with significant morbidity and mortality. Case presentation We describe the case of a 44-year-old woman with Eisenmenger syndrome secondary to a large secundum atrial septal defect. Her pulmonary vascular disease was treated with pulmonary vasodilators, but she experienced a progressive decline in exercise tolerance, increasing atrial arrhythmias, resulting in referral for transplantation. Her condition was complicated by significant recurrent haemoptysis in the context of extremely dilated pulmonary arteries and in-situ thrombosis, which prompted successful heart and lung transplantation. She made a slow recovery but remains well 3 years post-transplant. Conclusions Patients with Eisenmenger syndrome secondary to a pre-tricuspid lesion, such as an atrial septal defect have a natural history that differs to patients with post-tricuspid shunts; the disease tends to present later in life but is more aggressive, prompting early and aggressive medical intervention with pulmonary arterial hypertension therapies. This case illustrates that severe recurrent haemoptysis can be an indication for expediting transplantation in Eisenmenger syndrome patients.

Utilization of Quantitative Computed Tomography Assessment to Identify Bronchiolitis Obliterans Syndrome After Single Lung Transplantation

Lung ◽  
2021 ◽  
Vol 199 (1) ◽  
pp. 29-35
Author(s):  
Douglas Zaione Nascimento ◽  
Guilherme Watte ◽  
Felipe Soares Torres ◽  
Sadi Marcelo Schio ◽  
Leticia Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Transplantation ◽  
Bronchiolitis Obliterans ◽  
Quantitative Computed Tomography ◽  
Bronchiolitis Obliterans Syndrome ◽  
Single Lung Transplantation
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