Lung Transplant Program

St. Louis Children's Hospital

Lung transplantation is sometimes the only viable treatment option for children with end-stage pulmonary and pulmonary vascular disease. The pediatric lung transplant program at Washington University School of Medicine and St. Louis Children’s Hospital (SLCH) performed nearly half of all pediatric lung transplant procedures undertaken worldwide between 1990 through 2003 and continues to be one of the most active pediatric lung transplant programs in the world with more than 300 children having received lung or heart-lung transplants at our Institutions.  Washington University is a collaborator in multicenter studies of outcomes in pediatric lung transplant patients, funded by the National Institutes of Health through the Clinical Trials in Organ Transplantation in Children (CTOT-C) program.

Physicians from the Division of Allergy and Pulmonary Medicine and the Division of Cardiothoracic Surgery work closely with a multi-disciplinary team including, transplant nurse coordinators, pediatric cardiologists, respiratory and physical therapists, social workers, child life workers, psychologists, dieticians and financial coordinators. Each member of this team contributes to comprehensive support for the patient family and consultation, as needed to the referring physicians.

Potential transplant candidates are referred to SLCH from health care centers worldwide. After a thorough evaluation, acceptable candidates are listed with United Network of Organ Sharing (UNOS), the organization in the United States that manages the Organ Transplantation and Procurement Network (OPTN). The organ allocation policies for lung and heart-lung transplant take into account the recipient’s medical urgency and potential benefit from transplant as well as the blood type, height and geographic factors. The current policy for allocation of lungs is available on the OPTN web site.

Information for patients & parents

Learn more about the SLCH pediatric lung transplant program including a downloadable Lung Transplant Handbook.

For referring physicians

Children who are eligible for lung or heart-lung transplants have end-stage pulmonary or pulmonary vascular disease which has progressed to a point where there is limited life expectancy.

Timing of lung transplant is based on pulmonary function testing, cardiac catheterization as well as measures of overall health and well-being.

Selection criteria
  • Patients over the age of 17 years should be referred to the Barnes-Jewish Hospital Lung Transplant Program.
  • Children from birth to 17 years of age, with end stage pulmonary parenchymal or pulmonary vascular disease and:
    • Likelihood of recurrence of the disease after transplant is small.
    • No evidence of irreversible organ dysfunction likely to progress or complicate the transplant.
    • No contraindication to immunosuppression.
    • Family and patient committed to adherence to complicated medical regimens.
  • Child is psychologically stable with a stable family structure.
Disease states considered for lung transplantation
Chronic obstructive lung diseases
  • Cystic fibrosis
  • Bronchiolitis obliterans
  • Bronchiectasis
  • Bronchopulmonary dysplasia
Restrictive Lung Diseases
  • Surfactant protein disorders including surfactant protein B and C deficiency, ABCA3 and NKX2.1 (TTF-1) mutations
  • Interstitial lung disease
  • Pulmonary fibrosis (radiation, toxins, medications)
  • Pulmonary alveolar proteinosis
Pulmonary vascular diseases
  • Primary pulmonary hypertension
  • Pulmonary hypertension associated with congenital heart disease, repaired or unrepaired
  • Pulmonary atresia with nonconfluent hypoplastic pulmonary arteries
  • Pulmonary venous stenosis
  • Alveolar capillary dysplasia
Pre-transplant evaluation

All potential candidates undergo a comprehensive multi-disciplinary evaluation that includes:

Pulmonary function testing
  • Spirometry
  • Lung volumes
  • DLCO
  • Blood gases
  • Maximal inspiratory and expiratory pressures
  • Infant pulmonary function testing is performed for most children under 5
Cardiac evaluation
  • EKG
  • 2D echocardiogram
  • cardiac catheterization (as needed to evaluate pulmonary vascular disease)
  • Chest x-rays
  • High resolution chest CT
  • V/Q scan (in selected cases)
Laboratory evaluation
  • Measures of renal and liver function
  • Sputum culture
  • Viral serologies (EBV, CMV, varicella, herpes, hepatitis, HIV)
Other studies
  • Nutritional evaluation
  • Physical therapy evaluation (including 6 minute walk test)
  • Psychosocial evaluation

For information concerning patient referral and care, please contact the transplant coordinators at 314-454-4131.