Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri.
Division of Congenital Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, Texas.
Ann Thorac Surg. 2022 Jul;114(1):184-192. doi: 10.1016/j.athoracsur.2021.04.032. Epub 2021 Apr 27.
Lung transplantation is the definitive surgical treatment for end-stage lung disease. However, infants comprise less than 5% of pediatric cases. This study sought to provide an overview of infant lung transplantation outcomes over the past 3 decades by using linked United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) data.
Infants undergoing lung transplantation from 1989 to 2020 in UNOS were reviewed. UNOS and PHIS records for patients who underwent lung transplantation from 1995 to 2020 were linked using date of birth, sex, and date of surgery ± 3 days. The study assessed underlying diagnoses, pretransplant and posttransplant extracorporeal membrane oxygenation support, retransplant-free survival to discharge, hospital experience (≥1 annual transplant for ≥4 years in a 5-year period), operative decade, bronchiolitis obliterans syndrome, long-term survival, and functional status at latest follow-up.
A total of 112 lung transplants were performed in 109 infants over 31 years. Of these, 21 patients died before discharge, and 2 underwent repeat transplantation during the same admission. The study linked 80.6% (83 of 103) of UNOS and PHIS records. Hospital survival was lower for infants with idiopathic pulmonary hypertension and those who underwent transplant procedures at less experienced centers. All 7 infants requiring postoperative extracorporeal membrane oxygenation support died. Median freedom from bronchiolitis obliterans syndrome was 8.1 years (interquartile range, 4.6 to 11.6 years). After discharge, median survival was 10.3 years (interquartile range, 6.3 to 14.4 years), with improved 10-year survival for those patients who underwent transplantation from 2010 to 2020 (87.3%) vs 2000 to 2009 (52.4%; P = .098) and 1989 to 1999 (34.1%; P = .004). A total of 84.6% (33 of 39) of survivors had minor or no restrictions at latest follow-up.
Carefully selected infants experience promising short- and long-term outcomes after lung transplantation.
肺移植是治疗终末期肺部疾病的确定性手术治疗方法。然而，婴儿在儿科病例中所占比例不到 5%。本研究通过使用链接的器官共享联合网络（UNOS）和儿科健康信息系统（PHIS）数据，旨在提供过去 30 年婴儿肺移植结果的概述。
回顾了 1989 年至 2020 年期间在 UNOS 接受肺移植的婴儿。使用出生日期、性别和手术日期±3 天，将 1995 年至 2020 年期间接受肺移植的 UNOS 和 PHIS 记录进行链接。该研究评估了基础诊断、移植前和移植后体外膜氧合支持、出院时无再移植存活率、医院经验（5 年内至少有 1 个年度移植≥4 年）、手术十年、细支气管炎闭塞综合征、长期存活率和最新随访时的功能状态。
在 31 年期间，共有 109 例婴儿接受了 112 例肺移植。其中，21 例患者在出院前死亡，2 例患者在同一住院期间接受了再次移植。该研究链接了 80.6%（83/103）的 UNOS 和 PHIS 记录。特发性肺动脉高压和在经验较少的中心接受移植手术的婴儿的住院存活率较低。所有 7 例需要术后体外膜氧合支持的患儿均死亡。无细支气管炎闭塞综合征的中位无病生存期为 8.1 年（四分位距，4.6 至 11.6 年）。出院后，中位生存率为 10.3 年（四分位距，6.3 至 14.4 年），2010 年至 2020 年接受移植的患者 10 年生存率提高（87.3% vs 2000 年至 2009 年的 52.4%；P=.098）和 1989 年至 1999 年的 34.1%（P=.004）。在最新随访时，84.6%（33/39）的幸存者有轻微或无限制。
精心选择的婴儿在肺移植后可获得有希望的短期和长期结果。
