The 30000 patients currently awaiting transplantation in the United States include an increasing number of children and elderly adults.1 Transplantation in these two populations has its own unique characteristics. Experience with 52 neonates requiring cardiac transplantation has demonstrated survival of 86% and 84% at 1 and 5 years, respectively, with more than 90% of patients ultimately receiving maintenance therapy with cyclosporine alone.2
The use of reduced-size grafts (organ segments or lobes for transplantation) has helped to offset the shortage of pediatric donor organs; reduced-size liver transplants have reduced mortality of infants on waiting lists from 25% to 1%.3 Recently, a pulmonary lobe from an older donor was transplanted into a 4-week-old infant, resulting in good short-term function.4
Renal transplantation in elderly patients is increasingly common. A Swedish analysis of renal transplantation has shown that although mortality and morbidity were higher in recipients older than 60 years
Hardy MA, Goodman ER. Transplantation. JAMA. 1994;271(21):1716–1717. doi:10.1001/jama.1994.03510450088049
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