Children with chronic medical problems may have an increased need for surgery. Surgery may be needed to improve the underlying chronic condition or may be for causes independent of the chronic condition. For example , appendicitis may affect a child with asthma or diabetes.
The most common surgical procedures for children are repair of inguinal hernia, orchiopexy, and placements of ear tubes. Most of these procedures are performed under general anesthesia on an out-patient bases. Children with chronic disorders may have anesthetic risks beyond those of normal children so it may be prudent in some cases to perform the procedures as in-patients.
End-stage failure of some organ systems may be amenable to replacement. Kidney, heart, lung, and liver are the predominant organs that have been transplanted in children. Additional transplants include pancreas, small intestine, and increasingly multiple organ transplants are being performed. Patients accepted onto a hospital's tranplant waiting list are registered with the United Network for Organ Sharing, Organ Center where a centralized computer network links all organ procurement organizations and transplants centers. Various factors are involved for donor selection including blood type, tissue type, and size of the organ, and each organ has specific criteria.
In 1997, the UNOS reported 3.565 children and 76.526 adults were waiting for organ transplants. According to the International Pediatric Transplant Association, children in the USA receive 11 percent of total heart transplants, 7 percent of lung transplants, 13 percent of liver transplants, and about 5 percent of kidney transplants. A higher percentage of children than adults die waiting for transplant.
The importance of immunosuppression regimens in the improved survival of transplants cannot be overstressed. Regimens usualy involve prednisone, cyclosporine or tacrolimus, and mycophenolate mofetil of azathioprine. The major complications include infection, rejection, and malignancy, in addition to surgical problems.
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