LUNG TRANSPLANTATION IN CHILDREN AND YOUNG-ADULTS WITH CARDIOVASCULAR-DISEASE

Single or bilateral lung transplantation was performed in 20 patients with pulmonary hypertension or an inadequate pulmonary vascular bed; a ll but 1 had congenital heart disease. The average age was 6.3 years ( range, 3 months to 23.9 years). All were in New York Heart Association class IV, and 6 were hospitalized and receiving intensive support bef ore transplantation. Hospital survival was 70% (14/20), with three add itional deaths at 7, 11, and 27 months. A prior thoracic operation con tributed to three of six hospital deaths from hemorrhage. All late dea ths were due directly or indirectly to obliterative bronchiolitis. At a mean follow-up of 19 months (range, 2 to 48 months), 10 of 11 surviv ors are in New York Heart Association class I. Survival after hospital discharge and incidence of obliterative bronchiolitis are similar in a contemporary group of 41 patients of comparable age who underwent lu ng transplantation for pulmonary disease (p = not significant). Single or bilateral lung transplantation is an acceptable therapy for childr en with pulmonary hypertension, congenital heart disease, or both. Fur ther investigation in the areas of pretransplantation survival, operat ive risk factors, and long-term outcome of single-lung recipients and recipients with hemodynamically insignificant intracardiac lesions are needed to develop optimal decision-making strategies for these patien ts.