Pulmonary complications of tissue transplantation in children.

Pediatric bone marrow transplantation and transplantation of solid organs rapidly expanded during the 1980s. Antibiotic therapy for bacterial pneumonias, improved transplant preparative regimens, and improvements in prevention and therapy of graft-versus-host disease have made possible significant improvements in overall bone marrow transplant survival. Despite these advances, pulmonary complications of transplantation remain major causes of morbidity and mortality in pediatric transplant patients. Fungal and cytomegalovirus infections have emerged as the major posttransplant pulmonary infections whereas idiopathic interstitial pneumonias and bronchiolitis obliterans are the major noninfectious pulmonary problems. Recent developments in antiviral therapy for cytomegalovirus pneumonia offer hope that the dismal prognosis of cytomegalovirus pneumonia in transplant patients can be improved. New early detection methods for cytomegalovirus using polymerase chain reaction may also help identify patients for prophylactic therapy and prevent development of cytomegalovirus pneumonitis. Early diagnosis and treatment for fungal pneumonias and other opportunistic pathogens remain significant challenges in immunocompromised transplant patients.