Bridges N D, Mallory G B, Huddleston C B, Canter C E, Spray T L
Division of Pediatric Cardiology, Children's Hospital of Philadelphia/ University of Pennsylvania School of Medicine 19104, USA.
J Heart Lung Transplant. 1996 Sep;15(9):895-902.
Experience with lung transplantation in infants and young children is limited. Small size, vulnerability to infection, and limited modalities for rehabilitation and surveillance of the transplanted lung make this group particularly challenging.
We reviewed the course of all children up to the age of 25 months who underwent lung transplantation at two centers between July 1990 and February 1995.
Lung transplantation was performed in 17 patients under the age of 25 months, with concurrent cardiac repair in 14. Prior thoracic surgery had been performed in 12; six patients had mechanical ventilation, and three were supported with extracorporeal membrane oxygenation while waiting for lungs. The mean waiting time was 37 days (range 1 to 197 days). Hospital survival was 12 of 17 (71%); there was one late death. Early deaths were due to hemorrhage (two patients), cytomegalovirus and lymphoproliferative disease (one patients), and viral pneumonitis (two patients). The one late death was due to overwhelming gastroenteritis of unknown origin. One additional patient had graft failure caused by viral pneumonitis and underwent successful retransplantation. Bronchial stenosis occurred at 3 of 33 anastomoses. At a mean follow-up of 22 months, surviving patients were well, without supplemental oxygen, and, although small in stature, had normal linear growth.
Lung transplantation is a reasonable therapy for very young patients with limited life expectancy and no other therapeutic alternative, with outcomes comparable with those achieved in older patients. Early recognition of lung transplant candidates and advances in the prevention, diagnosis, and treatment of viral illness may improve survival in these patients.
婴幼儿肺移植的经验有限。患儿体型小、易感染，且移植肺的康复和监测方式有限，使得这一群体的治疗极具挑战性。
我们回顾了1990年7月至1995年2月期间在两个中心接受肺移植的所有25个月以下儿童的病程。
17例25个月以下患儿接受了肺移植，其中14例同时进行了心脏修复。12例曾接受过胸外科手术；6例患者需要机械通气，3例在等待供肺期间接受体外膜肺氧合支持。平均等待时间为37天（1至197天）。17例中有12例（71%）存活出院；有1例晚期死亡。早期死亡原因包括出血（2例）、巨细胞病毒和淋巴增殖性疾病（1例）以及病毒性肺炎（2例）。1例晚期死亡是由于不明原因的严重肠胃炎。另有1例患者因病毒性肺炎导致移植肺失败，再次移植成功。33例吻合口中有3例发生支气管狭窄。平均随访22个月时，存活患者情况良好，无需吸氧，尽管身材矮小，但线性生长正常。
对于预期寿命有限且无其他治疗选择的极年幼患者，肺移植是一种合理的治疗方法，其疗效与年长患者相当。早期识别肺移植候选者以及在病毒性疾病预防、诊断和治疗方面的进展可能会提高这些患者的生存率。
