Ro P S, Spray T L, Bridges N D
Department of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, 19104, USA.
J Heart Lung Transplant. 1999 Dec;18(12):1232-7. doi: 10.1016/s1053-2498(99)00087-x.
Little is known about outcome, characteristics, or organ availability for infants listed for lung or heart/lung transplantation.
Within a 45-month period at one institution, all pediatric patients who were listed for primary lung or heart/lung transplantation and who reached the end point of either transplant or death prior to transplant were identified. Outcomes for those patients listed as younger than and older than 1 year of age were compared.
Among 48 pediatric patients, 19 were infants less than one year of age. The median age among infants at listing was 3.7 months (range 0.5 to 8.9 months). Death before transplant occurred in 10 of 19 infants (53%) compared with 14 of 29 (48%) children. When comparing those infants who died prior to transplant with those who received organs, there were no significant differences with respect to size, blood type, age at listing, presence of pulmonary hypertension, or type of transplant for which the patient was listed. There was a trend toward poorer pre-transplant survival for infants when compared with children. Waiting times were significantly shorter for infants vs children (p = 0.02). The incidence of acute cellular rejection and serious infection was similar in the 2 groups. Infants had significantly longer hospitalization post-transplant and a trend toward poorer hospital survival, although survival at 1 year was comparable between the 2 groups.
The outcome for infants listed for lung or heart/lung transplantation is similar to that of children; thus, very young age should not be considered a contraindication to lung or heart/lung transplantation. Earlier diagnosis and listing may decrease pre-transplant mortality.
对于登记等待肺移植或心肺联合移植的婴儿,其治疗结果、特征或器官可用性了解甚少。
在一家机构的45个月期间内,确定所有登记等待初次肺移植或心肺联合移植且在移植前达到移植或死亡终点的儿科患者。比较登记年龄小于1岁和大于1岁患者的治疗结果。
在48例儿科患者中,19例为小于1岁的婴儿。登记时婴儿的中位年龄为3.7个月(范围0.5至8.9个月)。19例婴儿中有10例(53%)在移植前死亡,而29例儿童中有14例(48%)。将移植前死亡的婴儿与接受器官的婴儿进行比较,在大小、血型、登记时年龄、肺动脉高压的存在或患者登记的移植类型方面没有显著差异。与儿童相比,婴儿移植前的生存率有降低趋势。婴儿的等待时间明显短于儿童(p = 0.02)。两组急性细胞排斥反应和严重感染的发生率相似。婴儿移植后的住院时间明显更长,且医院生存率有降低趋势,尽管两组1年生存率相当。
登记等待肺移植或心肺联合移植的婴儿的治疗结果与儿童相似;因此,低龄不应被视为肺移植或心肺联合移植的禁忌证。早期诊断和登记可能会降低移植前死亡率。