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Heart-lung transplantation in infants, children, and adolescents
V A Starnes1, S E Marshall, N J Lewiston
1Department of Cardiovascular Surgery, Stanford University Medical Center, CA 94305.
Insights
Pediatric heart-lung transplants show promising survival rates despite rejection and infection challenges. Obliterative bronchiolitis impacts long-term survivors, suggesting further research for single-lung transplantation in children.
Area of Science:
- Pediatric surgery
- Cardiothoracic transplantation
- Pulmonology
Background:
- Heart-lung transplantation is a complex procedure for children with end-stage cardiopulmonary disease.
- Indications include primary pulmonary hypertension, congenital heart disease, pulmonary atresia, and cystic fibrosis.
- Limited data exists on outcomes in pediatric heart-lung transplant recipients.
Purpose of the Study:
- To evaluate the outcomes of pediatric heart-lung transplantation.
- To identify complications and survival rates in this cohort.
- To inform future strategies for pediatric lung transplantation.
Main Methods:
- Retrospective analysis of 10 pediatric heart-lung transplant cases.
- Data collection on diagnoses, age, rejection episodes, infections, survival, and complications.
- Actuarial survival analysis and assessment of functional status in survivors.
Main Results:
- Ten children (4 months-18 years) underwent heart-lung transplantation for various conditions.
- High rates of pulmonary rejection (1.67 episodes/patient) and infection (3.3 episodes/patient) were observed.
- 1- and 2-year actuarial survival rates were 78% and 47%, respectively, with obliterative bronchiolitis being a major complication in survivors.
Conclusions:
- Heart-lung transplantation in children can achieve acceptable survival rates.
- Pulmonary complications, particularly obliterative bronchiolitis, remain significant challenges.
- These findings support further investigation into pediatric lung transplantation, including single-lung options.
Abstract:
We have performed heart-lung transplantation in 10 children for the preoperative diagnoses of primary pulmonary hypertension (4), complex congenital heart disease with pulmonary hypertension (4), pulmonary atresia (1), and cystic fibrosis (1). Ages ranged from 4 months to 18 years. There were 15 episodes of pulmonary rejection, with an occurrence rate of 1.67 episodes per patient. Pulmonary infections occurred frequently, with an occurrence rate of 3.3 episodes per patient. The actuarial survival rate at 1 and 2 years was 78% and 47%, respectively. Patient attrition between 1 and 2 years was attributable to the complications of obliterative bronchiolitis, which has effected 71% (5/7) of the long-term survivors. Four of the 5 surviving children have minimal physical limitation and are in functional class I. These data support continued investigation into heart-lung transplantation in children and set the stage for further program development into single-lung transplantation in children.