Keshava Hari Balaji, Mason David Park, Murthy Sudish C, Brown Chase R, Pettersson Gosta B
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, United States.
Thorac Cardiovasc Surg. 2012 Jun;60(4):275-9. doi: 10.1055/s-0031-1298063. Epub 2012 Jan 7.
There is a limited experience using pediatric organs for adult lung transplantation (LTx), with size matching the major concern. We reviewed our experience transplanting pediatric donor lungs into adult recipients with endpoints of post-LTx complications and overall patient survival.
From 2/1990 to 12/2007, 609 adults underwent primary LTx at our institution. Thirty-eight (6.2%) patients underwent LTx with organs from pediatric donors (≤16 years). Of these, median donor age was 13 years (range: 7 to 16) and median recipient age 55 (range: 24 to 66). Endpoints analyzed included size matching accuracy, airway and pleural complications, time to extubation, intensive care unit (ICU) and hospital lengths of stay, as well as survival.
Gross undersizing of the donor lung was present in 2/38 (5.3%) and of the donor bronchus in 11/38 (29%). Five patients (13%) experienced a major postoperative airway complication. Thoracentesis prior to discharge was necessary in 4/38 (11%) patients and chest tube reinsertion in 10/38 (26%) for pleural effusion. Median time to extubation was 2 days. ICU and hospital lengths of stay were 6 and 16 days, respectively. Kaplan-Meier survival at 30 days, 1 year, 3 years, and 5 years post-transplant was 89%, 74%, 63%, and 55%.
Despite sizing concerns, transplantation of pediatric lungs into adult recipients is feasible. Size mismatch may predispose to higher rates of airway and pleural complications. Hospital course and overall survival appear comparable to adult-to-adult LTx, and concerns over size matching should not preclude pediatric organ use for adult candidates.
将小儿器官用于成人肺移植（LTx）的经验有限，主要问题是尺寸匹配。我们回顾了将小儿供体肺移植给成人受者的经验，以LTx术后并发症和患者总体生存率为终点指标。
1990年2月至2007年12月，609名成人在我们机构接受了初次LTx。38名（6.2%）患者接受了来自小儿供体（≤16岁）器官的LTx。其中，供体年龄中位数为13岁（范围：7至16岁），受者年龄中位数为55岁（范围：24至66岁）。分析的终点指标包括尺寸匹配准确性、气道和胸膜并发症、拔管时间、重症监护病房（ICU）和住院时间，以及生存率。
38例中有2例（5.3%）供体肺明显过小，38例中有11例（29%）供体支气管明显过小。5例患者（13%）发生了严重的术后气道并发症。38例中有4例（11%）患者出院前需要胸腔穿刺，38例中有10例（26%）因胸腔积液需要重新插入胸管。拔管的中位时间为2天。ICU和住院时间分别为6天和16天。移植后30天、1年、3年和5年的Kaplan-Meier生存率分别为89%、74%、63%和55%。
尽管存在尺寸方面的担忧，但将小儿肺移植给成人受者是可行的。尺寸不匹配可能导致气道和胸膜并发症的发生率更高。住院过程和总体生存率似乎与成人对成人的LTx相当，对尺寸匹配的担忧不应排除将小儿器官用于成人候选者。
