I. PEDIATRIC LUNG TRANSPLANTATION : EARLY RESULTS (招請講演, 第30回日本小児外科学会総会)
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概要
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From 7/90 to 10/93 48 lung transplants in 45 patients have been performed in our pediatric transplant program (0.25-23 years, mean age 9.8 years). Eight children had been on continous ventilator support for 3 days to 4.5 years prior to transplant and 3 were on extracorporeal membrane oxygenation. Indications for lung transplant in this pediatric population include: cystic fibrosis (N=15), pulmonary hypertension and associated congenital heart disease (N=17), pulmonary atresia, ventricular septal defect (VSD), and nonconfluent pulmonary atreries (N=4), pulmonary fibrosis (N=8), and acute respiratory distress syndrome (ARDS)(N=1). Three children underwent re-transplantation for acute graft failure (N=2) or chronic rejection (N=1). Twenty-eight (62%) patients have survived 1-36 months (mean 15 mo.) post transplant. Lung transplantation in children has been associated with acceptable early results, although modification of the adult implantation technique has been neccesary. Lung transplantation and repair of complex congenital heart defects is possible; heart/lung transplantation may only be required for patients with severe left heart dysfunction and associated pulmonary vascular disease. Bronchiolitis obliterans remains a major concern for longterm graft function in the pediatric lung transplant patient. Although most of the lung transplants performed druing development of clinical lung transplantation were in adults, lung transplantation for end-stage pulmonary disease has recently been extended to pediatric patients (1). Because children have different forms of end-stage pulmonary vascular disease and fibrotic pulmonary diseases than occur in adults, they represent a distinctly different group of lung transplant recipients. We report our experience in lung transplantation at St. Louis Children's Hospital with emphasis on the unusual indications for lung tranpslantation in the pediatric patient, modifications of the transplantation technique and the early results.
- 特定非営利活動法人日本小児外科学会の論文
- 1994-04-20