Woo M S, MacLaughlin E F, Horn M V, Wong P C, Rowland J M, Barr M L, Starnes V A
Cardiothoracic Transplant Team, Childrens Hospital Los Angeles, University of Southern California School of Medicine, USA.
Pediatr Transplant. 1998 Aug;2(3):185-90.
Living donor (LD) lobar lung transplantation is now an accepted alternative to cadaveric lung transplantation in selected patients with end-stage lung disease. This study reviews the Childrens Hospital Los Angeles LD experience of 17 patients (mean 13.2 +/- 2.7 yrs; range 9.3-18.5 yrs). 12 LD patients had end-stage cystic fibrosis, 4 had primary pulmonary hypertension, and 1 child had bronchiolitis obliterans. LD candidates must meet the same criteria as for cadaveric lung transplant candidates. Donor candidates are rigorously screened (physically and psychologically) prior to acceptance for lobectomy. LD patients receive the same triple immunosuppression regimen as our cadaveric recipients (prednisone, cyclosporine/FK506, and azathioprine/mycophenolate). Comparison of rejection episodes, incidence of bronchiolitis obliterans, pulmonary function tests, exercise stress tests, and cardiac catheterization data was made between LD and cadaveric lung transplantation (CL) pediatric recipients. Donor outcomes were also reviewed. In our pediatric program, the 1-year survival rate for LD recipients is currently 81%, which compares favorably with the ISHLT average of 70% for pediatric transplant patients. The incidence of rejection is about the same for LD and CL recipients, but the episodes are less severe for pediatric LD patients. There have been no histological cases of bronchiolitis obliterans syndrome in our LD recipients. Although there have been questions as to whether transplanted lobes can supply comparable pulmonary reserve to whole cadaveric lungs, the lung volumes (TLC and VC), expiratory flow rates, maximal exercise stress tests, and pulmonary artery pressures (no evidence of pulmonary hypertension) in LD patients are not significantly different to CL recipients in our institution. Besides pain from the thoracotomy, the donors have a decrease of 16% (right lower lobe donor) and 18% (left lower lobe donor) in their vital capacity. Otherwise, there have been no major complications to the donors and most have resumed their usual activities. Based on outcomes, pulmonary function tests, exercise stress tests, and hemodynamic studies as well as low donor morbidity, living donor double lobar lung transplantation is a viable alternative to cadaveric lung transplantation in selected pediatric patients with end-stage lung disease.
活体供体（LD）肺叶移植现已成为某些终末期肺病患者尸体肺移植的一种可接受的替代方案。本研究回顾了洛杉矶儿童医院17例活体供体肺移植患者的情况（平均年龄13.2±2.7岁；范围9.3 - 18.5岁）。12例活体供体肺移植患者患有终末期囊性纤维化，4例患有原发性肺动脉高压，1例儿童患有闭塞性细支气管炎。活体供体肺移植候选者必须符合与尸体肺移植候选者相同的标准。在接受肺叶切除术前，对供体候选者进行严格的（身体和心理）筛查。活体供体肺移植患者接受与我们尸体肺移植受者相同的三联免疫抑制方案（泼尼松、环孢素/FK506和硫唑嘌呤/霉酚酸酯）。对活体供体肺移植和尸体肺移植（CL）儿科受者的排斥反应发作、闭塞性细支气管炎发生率、肺功能测试、运动应激测试和心导管检查数据进行了比较。还回顾了供体的结局。在我们的儿科项目中，活体供体肺移植受者的1年生存率目前为81%，与国际心脏和肺移植学会（ISHLT）儿科移植患者70%的平均生存率相比更具优势。活体供体肺移植和尸体肺移植受者的排斥反应发生率大致相同，但儿科活体供体肺移植患者的发作不太严重。我们的活体供体肺移植受者中没有闭塞性细支气管炎综合征的组织学病例。尽管对于移植的肺叶是否能提供与整个尸体肺相当的肺储备存在疑问，但在我们机构中，活体供体肺移植患者的肺容量（TLC和VC）、呼气流量率、最大运动应激测试和肺动脉压力（无肺动脉高压证据）与尸体肺移植受者相比无显著差异。除了开胸手术引起的疼痛外，供体的肺活量下降了16%（右下叶供体）和18%（左下叶供体）。否则，供体没有出现重大并发症，大多数已恢复正常活动。基于结局、肺功能测试、运动应激测试和血流动力学研究以及供体低发病率，活体供体双肺叶移植是某些终末期肺病儿科患者尸体肺移植的一种可行替代方案。
