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Elective transplant pneumonectomy

A DeAnda1, J L Cahill, D Bernstein

  • 1Department of Pediatrics, Stanford Health Services, CA, USA.

Journal of Pediatric Surgery
|May 9, 1998
PubMed
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A modified single lung transplant (SLT) helped a neonate with congenital diaphragmatic hernia. Later, a transplant pneumonectomy successfully removed the failing transplanted lung, stopping immunosuppression and aiding recovery.

Area of Science:

  • Pediatric surgery
  • Pulmonary medicine
  • Transplantation immunology

Background:

  • Congenital diaphragmatic hernia (CDH) in neonates presents significant respiratory challenges.
  • Single lung transplantation (SLT) is a complex option for neonates with severe respiratory distress.
  • Long-term immunosuppression poses risks, especially in very young pediatric patients.

Observation:

  • A neonate with CDH received a modified SLT, enabling weaning from extracorporeal membrane oxygenation (ECMO).
  • By age 4, the patient exhibited failure to thrive, hypertension, and hirsutism, indicative of chronic immunosuppression side effects.
  • Ventilation-perfusion scans showed decreased right lung function, and right heart catheterization suggested tolerance for pneumonectomy.

Findings:

  • A successful transplant pneumonectomy was performed, removing the compromised transplanted lung.

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  • The procedure addressed diaphragmatic hernia recurrence and adhesions.
  • The patient was discharged with cessation of immunosuppression, showing immediate and medium-term recovery.

    • Implications:

    • Transplant pneumonectomy can be a viable option for managing complications of pediatric lung transplantation.
    • This approach may serve as a temporizing measure, allowing native lung development and potentially avoiding lifelong immunosuppression.
    • Successful cessation of immunosuppression highlights the potential for improved long-term outcomes in select pediatric lung transplant recipients.