student research day - Case Western Reserve University School of ...

Hari B. Keshava
USING PEDIATRIC DONOR LUNGS FOR ADULT RECIPIENTS: FEASIBILITY AND OUTCOMES
Hari B. Keshava, MS, David P. Mason, MD, Ann M. McNeill, RN, Sudish C. Murthy, MD, PhD, Marie M. Budev, DO,
Gosta B. Pettersson, MD, PhD
Case Western Reserve School of Medicine and Cleveland Clinic - Department of Thoracic and Cardiovascular
Surgery
OBJECTIVE: There is little information describing the impact of pediatric organ use in adult lung transplantation (LTx). Importantly, sizing
criteria classically applied in adult allograft sizing are less established for pediatric organs, particularly with regard to donor bronchi. We
reviewed our institutional experience of pediatric organ use for adult recipients, with emphasis on feasibility, bronchial anastomotic
complications, and overall patient survival.
METHODS: From 2/1990 to 1/2008, 609 adults underwent primary LTx at our institution. Of these, 43 (7.1%) underwent LTx with pediatric
allografts (donor less than 16 years old), and 39 medical records were available for review. Donor, recipient, and transplant variables, including
airway complications and ICU and hospital lengths of stay, were abstracted and analyzed. Institutional review board approval was given.
RESULTS: Median donor age was 14 years (range 7–16) and median recipient age 48 years (range 23–66). 24/39 (62%) underwent double LTx
and 15/39 (38%) single LTx. Median length of time until extubation was 2 days (range 1–49) and ICU length of stay 5 days (range 1–62). 10/39
(26%) were noted at the time of LTx to have important size mismatch of donor and recipient bronchi (all oversized recipient bronchi). 3/39
(8.0%) patients experienced a major postoperative airway complication: 2 had catastrophic airway dehiscence (1 lethal and the other requiring
reoperation), and 1 developed problematic airway stenosis requiring stenting. Kaplan-Meier survival at 30 days, 1 year, 3 years, and 5 years
post-transplant was 88%, 74%, 67%, and 60%, respectively.
CONCLUSION: At our institution, it was feasible to perform adult LTx with pediatric donors, which substantially increased the donor pool. Sizing
criteria for adults seem to be applicable to pediatric organs, although size mismatch of the airway was common. This may predispose to major
complications, suggesting that attention must be paid to matching both parenchymal and airway size. Overall survival after LTx appears similar
to that for adult donors.
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