Elective transplant pneumonectomy

Abe DeAnda, John L. Cahill, Daniel Bernstein, Vaughn A. Starnes, Bruce A. Reitz

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

The use of a single lung transplant, modified with removal of the middle lobe of the donor right lung, has been described for a term neonate with respiratory distress secondary to right-sided congenital diaphragmatic hernia. The successful transplant allowed the patient to be successfully weaned from extracorporeal membrane oxygenation. Because of the early age of the patient at transplantation (3 weeks), it was unclear how the patient's left lung would develop, and there was uncertainty regarding the risk of life-time immunosuppression. By the age of 4 years, 10 months, she was demonstrating some failure to thrive, hypertension, and hirsutism, obvious side effects of chronic immunosuppression. The question was raised as to the potential for transplant pneumonectomy. A ventilation-perfusion scan demonstrated a decrease of right lung ventilation compared with the immediate postoperative period (27% versus 43%); right heart catheterization with balloon occlusion of the right main pulmonary artery suggested that the patient would tolerate right pneumonectomy. After discussion with the family, the patient underwent transplant pneumonectomy via a right posterolateral approach. Findings at the time of operation included mild to moderate adhesions as well as recurrence of the diaphragmatic hernia. She tolerated the procedure well and was discharged home on the fifth postoperative day with cessation of her immunosuppression. The immediate and medium-term success of this procedure suggests the potential for temporizing transplantation as a palliation to promote survival until the remaining native lung can provide sufficient ventilation.

Original languageEnglish (US)
Pages (from-to)655-656
Number of pages2
JournalJournal of Pediatric Surgery
Volume33
Issue number4
DOIs
StatePublished - Apr 1998
Externally publishedYes

Keywords

  • Congenital diaphragmatic hernia
  • Extracorporeal membrane oxygenation
  • Neonatal lung transplantation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    DeAnda, A., Cahill, J. L., Bernstein, D., Starnes, V. A., & Reitz, B. A. (1998). Elective transplant pneumonectomy. Journal of Pediatric Surgery, 33(4), 655-656. https://doi.org/10.1016/S0022-3468(98)90339-6