Oral Session 2
Pediatric lung treatment

[ISPHLT-OS2-1] Living-donor single-lobe lung transplantation for pediatric pulmonary hypertension

^○Daisuke Nakajima¹, Shiro Baba², Tadashi Ikeda³, Satona Tanaka¹, Yoshito Yamada¹, Yojiro Yutaka¹, Akihiro Ohsumi¹, Masatsugu Hamaji¹, Hiroshi Date¹ (1.Department of Thoracic Surgery, Kyoto University, Japan, 2.Department of Pediatrics, Kyoto University, Japan, 3.Department of Cardiovascular Surgery, Kyoto University, Japan)

Living donor lobar lung transplantation is an important life-saving option for dealing with the severe donor organ shortage, especially for small children. This is a case report of successful single-lobe lung transplantation for severe pulmonary hypertension in children. [Case 1] A 6-year-old boy suffered from pulmonary hypertension and hypoxia secondary to alveolar capillary dysplasia with misalignment of pulmonary veins. He underwent living-donor single-lobe transplantation with the right lower lobe from his 31-year-old mother. The pre-transplant graft size matching was acceptable: the estimated graft forced vital capacity (FVC) was 96.5% of the recipient's predicted FVC, and the graft size measured by computed tomography volumetry was 166% of the recipient's chest cavity volume. Right pneumonectomy followed by implantation was performed under cardiopulmonary bypass (CPB). The pulmonary arterial pressure (PAP) was significantly decreased to 31/12 mmHg immediately after transplantation, and the first PaO₂/FiO₂ in the intensive-care unit (ICU) was 422 mmHg. Lung perfusion scintigraphy showed 97.5% perfusion to the right implanted lung three months after transplantation. [Case 2] Living-donor single-lobe transplantation was performed for a four-year-old boy with idiopathic pulmonary arterial hypertension. The right lower lobe from his 26-year-old mother was transplanted under CPB. The graft FVC size matching was 87.9% of the recipient's predicted FVC, and the graft size was 204% of the recipient's chest cavity volume. PAP was decreased from 115/60 mmHg to 22/9 mmHg just after transplantation, and the first PaO₂/FiO₂ in the ICU was 462 mmHg. Lung perfusion scintigraphy demonstrated 94.5% perfusion to the right implanted lung a month after transplantation. This case report validated the functional capacity of living-donor single lobe transplanted to deal with pulmonary arterial hypertension in small children.