Kaditis Athanasios G, Phadke Shruti, Dickman Paul, Webber Steven, Kurland Geoffrey, Michaels Marian G
Department of Pediatrics, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Pediatr Pulmonol. 2004 May;37(5):413-8. doi: 10.1002/ppul.20025.
Appreciable mortality accompanies pediatric lung and heart-lung transplantation. The objective of this investigation was to compare the clinical impression of causes of death with autopsy findings in all pediatric lung or heart lung transplant recipients who had an autopsy performed between 1985-2002 at the Children's Hospital of Pittsburgh. Medical records and autopsy findings were reviewed. Thirty recipients with autopsies had 33 transplant procedures: heart-lung (16), double lung (14), repeat lung (2), and repeat heart-lung (1). Perioperative deaths occurred in 8 children, most often precipitated by graft dysfunction. Early deaths (2 weeks-1 year) occurred in 12 children resulting from infection. Late deaths (greater than 1 year) occurred in 10 children. Bronchiolitis obliterans complicated by infection was the major cause of death in these recipients. An autopsy confirmed the clinical impression of cause of death in 29/30 and added significant supplemental information in 16 cases. Unsuspected factors contributing to death included donor lung abnormalities, concurrent infection, and cardiovascular disease. Postmortem examination remains a critical component to augment the understanding of causes of death following pediatric thoracic transplantation.
小儿肺移植和心肺移植伴随着相当高的死亡率。本研究的目的是比较匹兹堡儿童医院1985年至2002年间接受尸检的所有小儿肺移植或心肺移植受者的临床死因印象与尸检结果。回顾了病历和尸检结果。30名接受尸检的受者进行了33次移植手术：心肺移植（16例）、双肺移植（14例）、再次肺移植（2例）和再次心肺移植（1例）。8名儿童发生围手术期死亡，最常见的原因是移植物功能障碍。12名儿童在术后2周-1年发生早期死亡，死因是感染。10名儿童发生晚期死亡（超过1年）。闭塞性细支气管炎合并感染是这些受者的主要死因。尸检在29/30的病例中证实了临床死因印象，并在16例病例中提供了重要的补充信息。导致死亡的意外因素包括供体肺异常、并发感染和心血管疾病。尸检仍然是增强对小儿胸移植后死因理解的关键组成部分。
