Lillehei C W, Shamberger R C, Mayer J E, Burke R P, Koka B V, Arnold J, Wessel D L, Lanzberg M, Palazzo R
Department of Surgery, Children's Hospital, Boston, MA 02115.
J Pediatr Surg. 1994 Aug;29(8):1152-5; discussion 1155-6. doi: 10.1016/0022-3468(94)90299-2.
Donor scarcity and the limitations of organ preservation dictate that a wide size range be used to maximize effective donor utilization in pulmonary transplantation. Problems of size disparity are magnified in the pediatric population, where relevant dimensions vary considerably by age. There have been 10 pediatric lung recipients (7 bilateral, 2 single, 1 heart-lung) at our institution since 1991. The age range was 3 to 26 years (mean, 13.7), and the weight range was 15 to 57 kg (mean, 33.6). Diagnoses included cystic fibrosis (5), pulmonary fibrosis (2), pulmonary hypertension (2), and arteriovenous malformation (1). The donor-to-recipient weight ratio ranged from 0.45 to 1.9, and the donor-to-recipient thoracic height ratio ranged from 0.6 to 1.6. Lobar resection and delayed chest closure was required in one case and was successful. Cardiopulmonary bypass was used electively in seven cases. No reexplorations for bleeding were necessary. Two of the three hospital deaths resulted from right ventricular failure, judged to be secondary to excessive pulmonary artery pressures intraoperatively associated with small donor allografts. Elective bypass had not been used. Inhaled nitric oxide (6 patients) and/or extracorporeal membrane oxygenation (2 patients) were used for temporary postoperative support. The hospital survival rate was 70% (7/10). One late death occurred 14 months postoperatively and was caused by obliterative bronchiolitis. The authors conclude that size disparity is a significant problem in pediatric lung transplantation. However, with elective use of cardiopulmonary bypass and aggressive postoperative support, a broad size range can be used.
供体稀缺和器官保存的局限性决定了在肺移植中应采用较宽的尺寸范围，以最大限度地提高供体的有效利用率。尺寸差异问题在儿科患者中更为突出，因为相关尺寸会因年龄而有很大差异。自1991年以来，我们机构有10名小儿肺移植受者（7例双侧移植，2例单侧移植，1例心肺联合移植）。年龄范围为3至26岁（平均13.7岁），体重范围为15至57千克（平均33.6千克）。诊断包括囊性纤维化（5例）、肺纤维化（2例）、肺动脉高压（2例）和动静脉畸形（1例）。供体与受体的体重比范围为0.45至1.9，供体与受体的胸廓高度比范围为0.6至1.6。1例患者需要进行肺叶切除和延迟关胸，手术成功。7例患者选择性地使用了体外循环。无需因出血而再次手术探查。3例院内死亡患者中有2例死于右心室衰竭，判断是由于术中与小供体移植物相关的肺动脉压力过高所致。未使用选择性体外循环。6例患者使用了吸入一氧化氮，2例患者使用了体外膜肺氧合进行术后临时支持。医院生存率为70%（7/10）。1例晚期死亡发生在术后14个月，死因是闭塞性细支气管炎。作者得出结论，尺寸差异是小儿肺移植中的一个重要问题。然而，通过选择性使用体外循环和积极的术后支持，可以采用较宽的尺寸范围。
