Bilateral single-lung transplantation in children

Background This study examined our experience with bilateral single-lung transplantation in pediatric patients. Methods Between 1988 and 1995, we have performed 32 double-lung transplantations in children. The first 10 were performed en bloc, the following 22 by bilateral single-lung transplantation. Indications for bilateral single-lung transplantation were cystic fibrosis in 16 patients, primitive obliterative bronchiolitis in 1, pulmonary artery hypertension in 1, and retransplantation in 4. Patientsʹ ages ranged from 7 to 16 years (mean, 12 years). Four patients underwent a parenchymal reduction (lobectomy or bilobectomy). Bilateral single-lung transplantation was performed with a “clam-shell” incision, normothermic cardiopulmonary bypass, and a beating heart. Results There was one postoperative death (heart failure in a retransplantation patient). Bleeding was moderate, and 4 patients had a bloodless procedure. Bronchial healing was satisfactory, with 3 patients receiving temporary left main bronchus stenting. There were two hospital deaths (recurrent cytomegalovirus infection in a retransplantation patient and multiorgan failure at 2 months) and seven late deaths, caused by infection (mostly cytomegalovirus), obliterative bronchiolitis, or both. Actuarial survival was 75% at 1 year, 56% at 2 years, and 36% at 3 years. Conclusions We conclude that bilateral single-lung transplantation appears to be an acceptable technique, even in small children. Bronchial healing is satisfactory, and no revascularization procedure appears necessary. Midterm and long-term results are comparable with those of heart-lung transplants, and in view of the current problems with organ donation, we think it is an adequate strategy in pediatric lung parenchymal disease.