Lung transplantation in very young infants.
BACKGROUND
Established successes with adult lung transplantation have laid the foundation for extension of this therapeutic modality to infants and children dying of end-stage pulmonary disease. The purpose of this report is to convey our experience with 19 infants undergoing lung transplantation before the age of 6 months.


METHODS
Six patients with predominantly pulmonary vascular disease and 13 patients with primarily pulmonary parenchymal disease have undergone bilateral sequential lung transplantation at our institution since 1990. Mean age at transplant was 104 +/- 44 days, and mean weight was 4.9 +/- 1.6 kg.


RESULTS
Although early mortality (32%, 6/19) was higher than that previously reported for older pediatric age groups, long-term survival was similar (44% at a maximum follow-up of 6 years). Although anastomotic complications and infections occurred at a rate approximating that seen in older pediatric age groups, episodes of acute rejection appear to occur with decreased frequency. Similarly, at a mean follow-up of 3 years, only 2 (15%) of 13 long-term survivors have evidence of bronchiolitis obliterans. The functional residual capacity, as measured on infant pulmonary function tests, has gradually increased as the children have grown, suggesting that lung growth is occurring.


CONCLUSIONS
Bilateral lung transplantation is a viable alternative in infants dying of end-stage pulmonary disease. Efforts directed toward avoiding the complications that lead to early posttransplant mortality combined with the seemingly lower incidence of early and late rejection may provide long-term results better than those in other age groups.
Huddleston
C B
CB
Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO 63110, USA.
Sweet
S C
SC
Mallory
G B
GB
Hamvas
A
A
Mendeloff
E N
EN
D000206:Actuarial Analysis; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011668:Pulmonary Veno-Occlusive Disease / Q000401:mortality / Q000601:surgery; D013997:Time Factors