Lung retransplantation in children.
BACKGROUND
Early primary graft failure due to reperfusion injury may occur in up to 10% of all patients undergoing lung transplantation. Late graft failure in the form of bronchiolitis obliterans progressively increases in frequency as posttransplantation follow-up increases. In both situations, the degree of pulmonary dysfunction may worsen and result in the death of the recipient. The only treatment in many instances is retransplantation. The results in adults are reasonably well established.


METHODS
We reviewed our experience in children. Of the 136 transplant procedures performed to date in children, 14 have been retransplantations. Six patients required retransplantation for early primary graft failure and 8 underwent retransplantation for bronchiolitis obliterans.


RESULTS
There were three early and three late deaths. The actuarial survival at 2 years is 58%. The retransplant procedures were more complex than the primary transplant operations as evidenced by the longer time on cardiopulmonary bypass (199 +/- 71 versus 150 +/- 41 minutes; p < 0.01) and the greater volume of blood transfused (1,303 +/- 936 versus 570 +/- 300 mL; p < 0.01). Two of the long-term survivors who received transplants for bronchiolitis obliterans have subsequently had development of this same condition and 1 died secondary to this. In four instances living related donors were used for the retransplant procedure. The most striking difference in these procedures compared with those transplantations performed with cadaveric donors was the shorter donor lung ischemic times (99.5 and 123.3 minutes for the two lungs for living related donors and 251 and 293 minutes for the first and second lung for the cadaveric donors; p < 0.01).


CONCLUSIONS
We believe that lung retransplantation in children is a reasonable therapy to offer in the circumstance of severe graft dysfunction. In the older child, the option of living donor transplantation offers advantages that might offset of the overall higher risk of this procedure.
Huddleston
C B
CB
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, USA. huddleston_c@a1.kids.wustl.edu
Mendeloff
E N
EN
Cohen
A H
AH
Sweet
S C
SC
Balzer
D T
DT
Mallory
G B
GB
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002102:Cadaver; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D019520:Living Donors; D008168:Lung / Q000503:physiopathology; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods / Q000502:physiology; D008297:Male; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome