Heart, heart-lung, and lung transplantation in the first year of life.
Heart, heart-lung, and lung transplantation in the first year of life.
复制标题
生命第一年的心脏、心肺和肺移植。
DOI：
10.1016/0003-4975(92)91338-a
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Shumway,NE
中科院分区：
文献类型：
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作者：
Starnes,VA;Oyer,PE;Bernstein,D;Baum,D;Gamberg,P;Miller,J;Shumway,NE
17名小于1岁的婴儿因终末期心肺疾病接受了心脏（12）、心肺（3）和肺（2）移植。接受心脏移植的婴儿平均年龄为4.5个月（范围，19天至12个月），其中4例诊断为心肌病，8例诊断为先天性心脏病。8例患者中有4例（50%）为左心发育不良综合征。1年和2年的精算生存率为74%，与年龄较大的儿童的1年和2年生存率82%和69%相比，这一比例更高。与1岁以上儿童相比，婴儿的线性排斥率较低（每100患者日分别为0.61和1.48次）。在中期随访中，没有发现移植物动脉粥样硬化。免疫抑制包括环孢霉素、硫唑嘌呤和泼尼松三种药物方案。目标是在6个月内逐渐减少类固醇剂量，改为隔日使用类固醇或完全停止使用类固醇，并且12名婴儿中的6名已经实现了这一目标。本文报告5例婴幼儿心肺联合肺移植。每组各有1名婴儿死亡：1名婴儿继发于气道并发症和脓毒症，另1名婴儿死于肺脓毒症。来自一个较大和较年长的供体的肺叶被移植到一个4周大的婴儿体内，作为一个单肺移植，结果良好。3例存活婴儿分别于移植后24、18和2个月恢复良好。闭塞性细支气管炎在该组中临床上不明显。这些数据支持心脏、心肺和肺移植在生命第一年的临床疗效。
Seventeen infants less than 1 year of age have undergone heart (12), heart-lung (3), and lung (2) transplantation for end-stage cardiopulmonary disease. The infants undergoing heart transplantation had a mean age of 4.5 months (range, 19 days to 12 months) with the diagnosis of cardiomyopathy in 4 and congenital heart disease in 8. Four of the 8 patients (50%) bed hypoplastic left heart syndrome. Actuarial survival at 1 and 2 years was 74% and compared favorably with the survival of older children at 1 and 2 years of 82% and 69%. The linearized rejection rate was less in infants as compared with children more than 1 year of age (0.61 versus 1.48 episodes per 100 patient days). In intermediate follow-up, no graft atherosclerosis has been noted. Immunosuppression has included a three-drug protocol of cyclosporine, azathioprine, and prednisone. A steroid taper to alternate day steroids or off completely by 6 months has been the goal and has been accomplished in 6 of 12 infants. Heart-lung and lung transplantation has been performed in 5 infants. One infant in each group died: 1 infant secondary to airway complications and sepsis and another due to pulmonary sepsis. A pulmonary lobe from a larger and older donor was transplanted into a 4-week-old infant as a single-lung transplant with good outcome. The 3 surviving infants are well 24, 18, and 2 months after transplantation. Obliterative bronchiolitis has not been clinically apparent in this group. These data support the clinical efficacy of heart, heart-lung, and lung transplantation in the first year of life.