Pretransplant Management

The waiting time for pediatric lung transplantation is commonly longer that a year, and the mortality rate on the waiting list is at least 20-25%. Therefore, once the estimated life expectancy of the child reaches approximately 2 years, the child should be listed for transplantation. While on the waiting list, the child's nutritional status must be optimized and often requires supplemental enteric feedings. If on steroids, the dosage must be weaned to the lowest possible dose consistent with acceptable pulmonary function (preferably less than 0.1mg/kg/day prednisone). Patients should be enrolled in monitored physical therapy and pulmonary rehabilitation activities to optimize functional status. Sputum should be cultured regularly to exclude the presence of resistant organisms. All pulmonary infections must be recognized immediately and aggressively treated. Hemoglobin levels should be regularly checked in cyanotic patients; phlebotomy may be required for hemoglobin levels above 16 gm/dl.

0 0

Post a comment