Pediatric lung transplantation. The years 1985 to 1992 and the clinical trial of FK 506

Abstract

The application of lung transplantation to the pediatric population was a natural extension of the success realized in our adult transplantation program, which began in 1982. Twenty pediatric patients (age range 3 to 18 years) have had heart-lung (n = 11), double lung (n = 8), and single lung (n = 1) transplantation procedures. The causes of end-stage lung disease were primary pulmonary hypertension (n = 7), congenital heart disease (n = 5), cystic fibrosis (n = 4), pulmonary arteriovenous malformation (n = 2), graft-versus-host disease (n = 1), and desquamative interstitial pneumonitis (n = 1). Four (20%) patients had thoracic surgical procedures before the transplantation operation. The survival was 80% at a mean follow-up of 2 years. Immunosuppressive drugs included cyclosporine (n = 9) or FK 506 (n = 11) based therapy with azathioprine and steroids. Children were followed up by means of spirometry, transbronchial biopsy, and primed lymphocyte testing of bronchoalveolar lavage fluid. The mean number of treated episodes of rejection was 1.4 at 30 days, 0.5 at 30 to 90 days, and 1.4 at more than 90 days, and the first treated rejection episode occurred on average 28 days after the operation. Obliterative bronchiolitis developed in four (25%) of 16 patients surviving more than 100 days. Results of pulmonary function tests have remained good in almost all recipients. The greatest infectious risk was that of cytomegalovirus: one death and one case of pneumonia. Posttransplantation lymphoproliferative disease was diagnosed in two (12.5%) patients; both recovered. The most common complications were hypertension (25%) and postoperative bleeding (15%). Early results indicate that lung transplantation is a most promising therapy for children with severe vascular and parenchymal lung disease.

Fig. 1

A decade of lung transplantation, 1982 to 1992, University of Pittsburgh Medical Center.

Fig. 2

Pediatric lung transplantation, 1985 to 1992. A-V, Arteriovenous.

Fig. 3

Pediatric lung transplantation, survival—1985 to 1992.

Fig. 4

Transesophageal echocardiogram, posttransplantation day 4, demonstrating right pulmonary venous thrombus with extension into the left atrium. T, Thrombus; LA. left atrium.

Fig. 5

Transesophageal echocardiogram after repair of right pulmonary venous anastomosis under cardiopulmonary bypass, posttransplantation day 5, LA, Left atrium.