Chen Ying, Kuang Minting, Lai Meiqi, Zhang Guolong, Yu Jiahui, Wu Daqun, Wang Chaoping, Yang Chao, Peng Guilin, Ruan Liang, Huang Danxia
Department of Organ Transplantation, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Transl Pediatr. 2025 Aug 31;14(8):2047-2056. doi: 10.21037/tp-2025-253. Epub 2025 Aug 27.
Heart-lung transplantation is a critical intervention for pediatric end-stage cardiopulmonary diseases, including severe pulmonary hypertension. Post-transplant rejection, predominantly pulmonary, poses significant challenges. Tubeless spontaneous ventilation is an emerging anesthetic modality that improves prognosis by minimizing the risk of mechanical ventilation.
This case report details a 15-year-old male patient who met the indications for combined heart-lung transplantation due to severe pulmonary hypertension in combination with right heart failure. The patient underwent combined heart-lung transplantation under tubeless spontaneous ventilation anesthesia. On postoperative day 6, the patient was observed to have early signs of pulmonary rejection, which was confirmed by testing for non-human leukocyte antigen antibodies. A tailored immunosuppressive regimen, including mycophenolate mofetil, methylprednisolone, and tacrolimus, was initiated. The patient also received antimicrobial treatment, along with nutritional support. On postoperative day 15, chylothorax was diagnosed, which was managed through fasting and modification of antifungal therapy due to hepatic dysfunction. Furthermore, exercise rehabilitation constitutes a significant component of the treatment regimen that patients receive. A phased rehabilitation program is a structured, multifaceted approach to recovery that encompasses all aspects of the patient's hospitalization. It incorporates active and passive physical activities, postural and endurance training, respiratory muscle training, and other exercises, all meticulously designed to address the patient's specific needs and facilitate their recovery. The patient exhibited a marked recovery in clinical symptoms by day 23 and was subsequently discharged from the hospital.
Tubeless anesthesia has been demonstrated to expedite postoperative recovery and mitigate pulmonary complications. Early rejection detection, tailored immunosuppression, and multidisciplinary coordination were instrumental in overcoming challenges. This case underscores the potential to reduce morbidity and highlights integrative strategies for optimizing transplant outcomes in children, emphasizing personalized care and vigilant monitoring.
心肺移植是治疗小儿终末期心肺疾病（包括重度肺动脉高压）的关键干预措施。移植后排斥反应（主要是肺部排斥）带来了重大挑战。无管自主通气是一种新兴的麻醉方式，通过将机械通气风险降至最低来改善预后。
本病例报告详细介绍了一名15岁男性患者，该患者因重度肺动脉高压合并右心衰竭而符合心肺联合移植指征。患者在无管自主通气麻醉下接受了心肺联合移植。术后第6天，观察到患者出现肺部排斥的早期迹象，通过检测非人类白细胞抗原抗体得以确诊。启动了量身定制的免疫抑制方案，包括霉酚酸酯、甲泼尼龙和他克莫司。患者还接受了抗菌治疗以及营养支持。术后第15天，诊断出乳糜胸，由于肝功能障碍，通过禁食和调整抗真菌治疗进行处理。此外，运动康复是患者接受的治疗方案的重要组成部分。分阶段康复计划是一种结构化、多方面的康复方法，涵盖患者住院的各个方面。它包括主动和被动体育活动、姿势和耐力训练、呼吸肌训练以及其他运动，所有这些都是精心设计的，以满足患者的特定需求并促进其康复。到第23天，患者临床症状明显恢复，随后出院。
已证明无管麻醉可加快术后恢复并减轻肺部并发症。早期排斥反应检测、量身定制的免疫抑制和多学科协调对于克服挑战至关重要。本病例强调了降低发病率的潜力，并突出了优化儿童移植结果的综合策略，强调个性化护理和密切监测。
