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Comprehensive evaluation of lung allograft function in infants after lung and heart-lung transplantation
Don Hayes1, Aymen Naguib2, Stephen Kirkby1
1Section of Pulmonary Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Insights
A new protocol safely evaluates infant lung allograft function using sedation for pulmonary function tests, CT scans, and bronchoscopy. This comprehensive approach allows for safe outpatient assessment in pediatric transplant recipients.
Area of Science:
- Pediatric critical care medicine
- Thoracic transplantation
- Allograft immunology
Background:
- Limited data exists on evaluating allograft function in infant lung and heart-lung transplant recipients.
- A procedural protocol was developed involving sedation for pulmonary function testing, CT imaging, and bronchoscopy with biopsies.
Purpose of the Study:
- To assess the safety and efficacy of a developed procedural protocol for evaluating infant lung allografts post-transplantation.
- To determine the feasibility of performing these evaluations as an outpatient procedure.
Main Methods:
- Retrospective review of children under 1 year old who underwent lung or heart-lung transplantation.
- Utilized a protocol involving sedation (propofol +/- ketamine) for pulmonary function tests, CT scans, and flexible fiberoptic bronchoscopy with transbronchial biopsies.
- Analyzed data on procedural sessions, patient disposition (outpatient vs. inpatient), and sedation times.
Main Results:
- Five infants (3 heart-lung, 2 lung) underwent thoracic transplantation since 2005.
- Out of 24 procedural sessions for allograft evaluation, 83% were for asymptomatic surveillance.
- 80% of surveillance procedures were performed on an outpatient basis, with 88% of these patients discharged the same day.
Conclusions:
- A comprehensive procedural protocol for evaluating allograft function in infant lung and heart-lung transplant recipients can be safely performed.
- The protocol is effective for outpatient assessment, improving patient management and potentially reducing healthcare costs.
Background:
Limited data exist on methods to evaluate allograft function in infant recipients of lung and heart-lung transplants. At our institution, we developed a procedural protocol in coordination with pediatric anesthesia where infants were sedated to perform infant pulmonary function testing, computed tomography imaging of the chest, and flexible fiberoptic bronchoscopy with transbronchial biopsies.
Methods:
A retrospective review was performed of children aged younger than 1 year who underwent lung or heart-lung transplantation at our institution to assess the effect of this procedural protocol in the evaluation of infant lung allografts.
Results:
Since 2005, 5 infants have undergone thoracic transplantation (3 heart-lung, 2 lung). At time of transplant, the mean ± standard deviation age was 7.2 ± 2.8 months (range, 3-11 months). Of 24 procedural sessions performed to evaluate lung allografts, 83% (20 of 24) were considered surveillance where the patients were completely asymptomatic. Of the surveillance procedures, 80% were performed as an outpatient, whereas 20% were done as inpatients during the lung or heart-lung transplant post-operative period before discharge home. Sedation was performed with propofol alone (23 of 24) or in addition to ketamine (1 of 24) infusion; mean sedation time was 141 ± 39 minutes (range, 70-214) minutes. Of the 16 outpatient procedures, patients were discharged after 14 (88%) on the same day, and after 2 (12%) were admitted for observation, with 1 being due to transportation issues and the other due to fever during the observation period.
Conclusions:
A comprehensive procedural protocol to evaluate allograft function in infant lung and heart-lung transplant recipients was performed safely as an outpatient.
