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Pediatric heart-lung transplantation: intermediate-term results
J V Conte1, R C Robbins, H Reichenspurner
1Department of Cardiothoracic Surgery, University of Maryland Medical System, Baltimore, USA.
Summary
Pediatric heart-lung transplants show survival rates comparable to adults, with long-term success achieved. Key challenges for improved outcomes in pediatric heart-lung transplantation include infection and obliterative bronchiolitis.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pediatric Pulmonology
Background:
- Stanford University initiated adult heart-lung transplantation in 1981 and pediatric heart-lung transplantation in 1986.
- This study presents intermediate-term outcomes of pediatric heart-lung transplantation performed at Stanford.
Purpose of the Study:
- To evaluate the outcomes of pediatric heart-lung transplantation.
- To identify factors affecting survival in pediatric heart-lung transplant recipients.
Main Methods:
- A retrospective review of all pediatric heart-lung transplantations performed since 1986 at Stanford University.
- Analysis included patient demographics, diagnoses, wait times, clinical status, survival rates, and causes of mortality.
Main Results:
- Nineteen heart-lung transplantations were performed in 17 pediatric patients (ages 2 months to 18 years).
- Actuarial survival at 1, 3, and 5 years was 67%, 51%, and 41% for all patients, respectively.
- Obliterative bronchiolitis (32%) and infection were significant causes of mortality and morbidity, alongside graft failure and multisystem organ failure.
Conclusions:
- Pediatric heart-lung transplantation survival rates approximate those of adult procedures at 1, 3, and 5 years.
- Long-term survival is achievable, but infection and obliterative bronchiolitis remain primary limitations.
- Further research is needed to mitigate these complications and improve long-term outcomes in pediatric heart-lung transplantation.