Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX77030, USA.
J Heart Lung Transplant. 2013 Jan;32(1):44-9. doi: 10.1016/j.healun.2012.09.027. Epub 2012 Nov 17.
There have been >1,600 pediatric lung transplantations (LTx) performed worldwide with a trend toward improved outcomes over the last 25 years. The majority of these LTxs have been in older children and adolescents. Less than 4 infant (defined as ≤ 12 months of age) LTxs per year have been performed over the past 20 years, mostly in the USA. However, infant LTx outcomes have not been well documented in a multi-institutional longitudinal fashion.
The United Network of Organ Sharing database was queried from October 1987 to July 2011. Of the 1,003 pediatric LTxs reported, 84 (8%) were infants. All combined transplantations were excluded.
Eighty-one infants received 84 LTxs, of which 95% had a bilateral LTx. Median age and weight at LTx was 4 months (range 0 to 11 months) and 5.3 kg (2.7 to 11.8 kg), respectively. Median ischemic time was 5.2 hours (2.0 to 10.8 hours). Overall Kaplan-Meier graft survival was similar for infants compared with other pediatric age group (OPA: >1 to 18 years) LTx recipients (half-life 4.0 years vs 3.4 years, p = 0.7). Conditional 1-year graft survival for infants was significantly higher than OPA (half-life 7.4 years vs 5.0 years, p = 0.024). Early (1987 to 2000, n = 46) and late (2001 to 2011, n = 38) era graft survival was not significantly different. Graft survival in pre-LTx ventilated infants was significantly better than pre-LTx ventilated OPA (half-life 6.1 years vs 0.9 year, p = 0.004) and was not statistically different from pre-LTx infants not on ventilatory support (half-life 6.1 years vs 2.2 years, p = 0.152). Cox regression of 5 variables (weight, donor arterial PO(2), pre-Tx ventilator, organ ischemic time, center experience) showed that survival was associated with increased center experience (p = 0.03).
Infants undergoing LTx have outcomes similar to those of all other pediatric LTx patients.
全球范围内已经进行了超过 1600 例小儿肺移植（LTx），过去 25 年来，其结果呈改善趋势。这些 LTx 大多数发生在年龄较大的儿童和青少年中。过去 20 年来，每年进行的婴儿（定义为≤12 个月龄）LTx 不到 4 例，主要在美国进行。然而，婴儿 LTx 的结果并没有以多机构纵向的方式得到很好的记录。
从 1987 年 10 月到 2011 年 7 月，查询了美国器官共享联合网络数据库。在报告的 1003 例小儿 LTx 中，84 例（8%）为婴儿。所有联合移植均被排除在外。
81 名婴儿接受了 84 例 LTx，其中 95%接受了双侧 LTx。LTx 时的中位年龄和体重分别为 4 个月（0 至 11 个月）和 5.3 公斤（2.7 至 11.8 公斤），中位缺血时间为 5.2 小时（2.0 至 10.8 小时）。与其他儿科年龄组（OPA：>1 至 18 岁）LTx 受者相比，婴儿的总体 Kaplan-Meier 移植物存活率相似（半衰期 4.0 年与 3.4 年，p=0.7）。婴儿的 1 年条件移植物存活率明显高于 OPA（半衰期 7.4 年与 5.0 年，p=0.024）。早期（1987 年至 2000 年，n=46）和晚期（2001 年至 2011 年，n=38）时期的移植物存活率无显著差异。LTx 前接受通气婴儿的移植物存活率明显优于 LTx 前通气 OPA（半衰期 6.1 年与 0.9 年，p=0.004），与 LTx 前未接受通气支持的婴儿无统计学差异（半衰期 6.1 年与 2.2 年，p=0.152）。对 5 个变量（体重、供体动脉 PO2、LTx 前呼吸机、器官缺血时间、中心经验）进行 Cox 回归分析显示，存活率与中心经验的增加有关（p=0.03）。
接受 LTx 的婴儿的结果与所有其他小儿 LTx 患者相似。
