第57回日本小児循環器学会総会・学術集会

講演情報

International Symposium of Pediatric Heart and Lung Transplantation

Oral Session 2
Pediatric lung treatment

2021年7月10日(土) 11:20 〜 12:00 Track6 (現地会場)

Chair:Yasushi Shintani(General Thoracic Surgery, Osaka University Graduate School of Medicine, Japan)

[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.