The Use of Extracorporeal Membrane Oxygenation for Perioperative Support in Pediatric Lung Transplantation Patients
Brian Duncan in Mechanical Support for Cardiac and Respiratory Failure in Pediatric Patients, 2001
Lung transplantation emerged as a modality to treat end-stage lung disease in the 1980s. Early in this experience, extracorporeal membrane oxygenation (ECMO) was attempted as a support measure in those patients in whom all other attempts at stabilization had proven inadequate. At that time, the need for ECMO was (and is in some centers) considered to be a contraindication to lung transplantation due to the dismal survival rates of patients transplanted during ECMO support (1). Additionally, lung transplantation and its concomitant immunosuppression has been considered a contraindication to posttransplant ECMO support (2). However, at the present time, ECMO provides the only effective means of "mechanical support" for the patient dying from pulmonary failure, on the basis of parenchymal or pulmonary vascular disease.
Congenital cardiac anomalies
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Extracardiac congenital anomalies have long been recognised to be associated with congenital heart disease. Advances in molecular biology, genetic testing and epidemiologic studies have enhanced our understanding of the various associated genetic syndromes. A number of distinguishing long-term sequelae of treated and untreated congenital heart disease have been described. Bronchiolitis obliterans is the manifestation of chronic rejection following lung transplantation. Duodenal atresia may be associated with Down's syndrome, and as a result with ventricular septal defects or atrioventricular canal defects, although most often there is no associated congenital heart disease lesion. Pulmonary vascular occlusive disease is end-stage lung disease resulting from chronic pulmonary hypertension from unrepaired congenital heart disease. Double aortic arch is usually without other associated congenital heart disease lesions and has a left and a right aortic arch. Symptoms may be respiratory or oesophageal. Ventricular septal defects are common associations with other congenital heart lesions.
Chpater 17. Function of the Transplanted Lung
G John Gibson in Clinical Tests of Respiratory Function, 2008
The increasing use of lung transplantation over the past 20 years has provided a major focus for evaluating respiratory function, both in pre-transplant assessment and in post-transplant monitoring. Among the many factors that influence the function of transplanted lungs are the following: •Nature of the pre-transplant disease: the advanced stages of many diseases are accepted indications for transplantation. These include various types of interstitial lung disease, in which the native lungs are generally shrunken and fibrotic and a marked restrictive ventilatory defect is present; chronic airway disease, particularly chronic obstructive pulmonary disease (COPD) and cystic fibrosis, in which varying degrees of lung and chest wall hyperinflation are present; and pulmonary hypertension, both primary and secondary to congenital heart disease, in which mechanical abnormalities of the native lungs and chest wall are minor or absent.
Lung transplantation in patients with cystic fibrosis: special focus to infection and comorbidities
Published in Expert Review of Respiratory Medicine, 2014
Daniel J Dorgan, Denis Hadjiliadis
Despite advances in medical care, patients with cystic fibrosis still face limited life expectancy. The most common cause of death remains respiratory failure. End-stage cystic fibrosis can be treated with lung transplantation and is the third most common reason for which the procedure is performed. Outcomes for cystic fibrosis are better than most other lung diseases, but remain limited (5-year survival 60%). For patients with advanced disease lung transplantation appears to improve survival. Outcomes for patients with Burkholderia cepacia remain poor, although they are better for patients with certain genomovars. Controversy exists about Mycobacterium abscessus infection and appropriateness for transplant. More information is also becoming available for comorbidities, including diabetes and pulmonary hypertension among others. Extra-corporeal membrane oxygenation is used more frequently for end-stage disease as a bridge to lung transplantation and will likely be used more in the future.
Special considerations for the use of lung transplantation in pediatrics
Published in Expert Review of Respiratory Medicine, 2016
Florian A Schmid, Christian Benden
Lung transplantation has become an accepted therapy in infants, children and adolescents suffering from end-stage lung diseases, an impaired quality of life as well as a reduced life expectancy. Within Europe, pediatric lung transplantation is largely performed in predominantly adult centers due to a relatively low overall case volume. Children do represent a specific and challenging cohort facing a transplant procedure, where the selection of potential candidates becomes a crucial step to maximize net survival benefit. Therefore, interdisciplinary evaluation and early listing in view of current indications and contraindications, adequate preoperative education of the child and family members, discussion of possibly required bridging procedures in case of deterioration, appropriate technical planning of the operation, adherence to postoperative medical treatment and follow-up are all crucial steps in this demanding puzzle. In this article, the authors review recent advances in the field of pediatric lung transplantation and outline challenges in the future.
The impact of chronic rhinosinusitis on long-term survival in lung transplantation recipients
Published in Acta Oto-Laryngologica, 2017
Shin Kariya, Mitsuhiro Okano, Takahiro Oto, Takaya Higaki, Takenori Haruna, Yohei Noda, Kazunori Nishizaki
Conclusions: Chronic rhinosinusitis diagnosed according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2012, not by computed tomography alone, is one of the prognostic factors affecting long-term survival in patients with lung transplantation. Endoscopic sinus surgery might play a beneficial role in the management of lung transplantation recipients with chronic rhinosinusitis. Objective: To show the effect of paranasal sinus infection on post-lung transplantation survival. Method: Lung transplantation recipients were included in this study. Computed tomography was performed before and after lung transplantation. The severity of chronic rhinosinusitis was evaluated by Lund–Mackay scoring system. The survival rate was calculated by the Kaplan–Meier method. Results: One hundred and forty-eight patients received lung transplantation for various indications. Chronic rhinosinusitis was found in 18.9% (28/148) of the lung transplantation recipients. Of 28 patients with chronic rhinosinusitis, seven patients underwent endoscopic sinus surgery due to persistent post-nasal drip. The recipients with chronic rhinosinusitis who did not receive endoscopic sinus surgery (n = 21) showed a significantly lower survival rate as compared to the patients without chronic rhinosinusitis. There was no statistically significant difference in the survival rate between the recipients with (n = 50) and without (n = 98) paranasal sinus abnormality on computed tomography.
Related Knowledge Centers
- Idiopathic Pulmonary Fibrosis
- Pulmonary Hypertension
- Respiratory Failure
- Cystic Fibrosis
- Lung
- Emphysema
- Alpha 1-Antitrypsin Deficiency