Transplantation has increasingly become an accepted treatment modality for children with endstage organ disease. According to the American Society of Transplant Physicians, indications for renal transplantation in childhood include symptoms of uremia and metabolic abnormalities that are unresponsive to standard therapy, failure to thrive due to dietary limitations, delayed psychomotor development due to renal impairments, and significant bone disease resulting from renal osteodystrophy (Davis et al. 1998). The most common disease indications for pediatric kidney transplantation include glomerulonephritis, chronic pyelonephritis, and hereditary conditions, such as polycystic kidneys (Rodrigue and Sobel 2003).

Pediatric heart transplantation is a treatment option for patients with end-stage heart failure who do not respond to standard drug therapy, the use of mechanical assist devices, or cardiac surgical procedures. The two leading causes of pediatric heart transplantation are complex congenital heart disease and endstage cardiomyopathy (Rodrigue and Sobel 2003). Congenital heart diseases, such as hypoplastic left heart syndrome, account for approximately 75% of cardiac transplants in the infant population (Tjang et al. 2008). However, the most common cause of cardiac transplantation across pediatric patients is dilated cardiomyopathy (Towbin et al. 2006). Accord ing to records and multicenter reviews of the United Network for Organ Sharing (UNOS), graft vasculop-athy was the primary indication for retransplantation among children (Canter et al. 2007).

Irreversible liver failure is an indication for liver transplantation among pediatric patients. Although biliary atresia, an absence or closure of liver bile ducts, is the most common reason for liver transplantation in children (Kerkar and Emre 2007), other common childhood reasons for liver transplantation include hepatocellular dysfunction (acute hepatic failure, autoimmune liver diseases, hepatitis, polycystic liver disease), metabolic disorders (Wilson's disease, inborn errors of metabolism, enzyme deficiencies), and liver neoplasms (hepato-blastoma and hepatocellular carcinoma).

Lung transplantation is a surgical option for pe-diatric patients with end-stage lung disease or life-threatening pulmonary vascular disease. Congenital heart disease is the most common reason for lung transplantation in infants (Faro et al. 2007). Although cystic fibrosis is the most common indication in children older than age 6 years and in young adults (Aurora et al. 2007), other common diagnoses that may culminate in pediatric lung transplantation include pulmonary vascular disease, interstitial lung disease, and bronchiolitis obliterans (Faro et al. 2007).

UNOS was established in 1984 with the goal of setting standards for transplantation and the accreditation of transplant centers. UNOS directs the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. Given the shortage of available organs, one of the main functions of UNOS is to oversee the allocation and distribution of organs in an unbiased manner. Each organ type has its own specific criteria, including, for example, blood type, tissue match, organ size, illness severity, length of time on waiting list, geographic location, and immune status (Slater 2002).

Your Heart and Nutrition

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