Bronchial artery revascularization and en bloc lung transplant in children

Guzmán-Pruneda, Francisco A.; Orr, Yishay; Trost, Jeffrey G.; Zhang, Wei; Das, Shailendra; Melicoff, Ernestina; Maddox, J.; Nugent, Melissa; Mery, Carlos M.; Adachi, Iki; Schecter, M.G.; Mallory, George B.; Morales, David L.S.; Heinle, Jeffrey S.; McKenzie, E. Dean

doi:10.1016/j.healun.2015.08.010

Cited by 31 publications

(13 citation statements)

References 21 publications

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“…To minimize airway ischemia, the technique of bronchial arterial revascularization (BAR) with lung transplantation has been reported. 44,45,[50][51][52][53][54][55][56] Successful lung transplant with BAR requires: (1) lung donor procurement that includes the proximal descending aorta and preservation of the donor bronchial artery/arteries; (2) accurate identification of the bronchial artery/arteries during back-table donor organ preparation; and (3) primary revascularization of the bronchial artery/arteries with an aortic patch technique or with internal mammary artery or venous conduit. [51][52][53] A limited number of recent, retrospective, single-center studies reported lower rates of airway ischemia with BAR in both adults and children.…”

Section: Surgerymentioning

confidence: 99%

“…[51][52][53] A limited number of recent, retrospective, single-center studies reported lower rates of airway ischemia with BAR in both adults and children. 54,55 The role of BAR in mitigating longer term complications, such as bronchiolitis obliterans syndrome, remains controversial. 56,57 The type of anastomotic reconstructive technique may also influence outcomes.…”

Section: Surgerymentioning

confidence: 99%

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ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics

Crespo

McCarthy

Hopkins

et al. 2018

The Journal of Heart and Lung Transplantation

145

144

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Airway complications remain a major cause of morbidity and mortality after cardiothoracic transplantation. The reported incidence of airway ischemic complications varies widely, contributed to by the lack of a universally accepted grading system and standardized definitions. Furthermore, the majority of the existing classification systems fail to integrate the wide range of possible bronchial complications that may develop after lung transplant. Hence, a Working Group was created by the International Society for Heart and Lung Transplantation with the aim of elaborating a universal definition of adult and pediatric airway complications and grading system. One such area of focus is to understand the problem in the context of a more standardized consensus of classifying airway ischemia. This consensus definition will have major clinical, therapeutics, and research implications.

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Section: Surgerymentioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics

Crespo

McCarthy

Hopkins

et al. 2018

The Journal of Heart and Lung Transplantation

145

144

View full text Add to dashboard Cite

show abstract

“…be performed while the aorta is cross clamped; however, the pulmonary venous anastomoses can be done separately with the heart beating if preferred. 20,27 The main pulmonary arterial anastomosis can also be performed before the pulmonary venous anastomosis if desired by the surgeon. This technique, currently the preferred method for infants transplanted at SLCH, is illustrated in the accompanying operative video (Video S1).…”

Section: En Bloc Double Lung Transplantmentioning

confidence: 99%

“…On the back table, at least one bronchial artery to each mainstem bronchus should be identified and prepared as an aortic button with a cuff of aortic tissue still intact. 20 Median sternotomy or clamshell is performed for the recipient. Following bilateral pneumonectomies and appropriate preparation of the recipient trachea, the donor bloc is placed into the chest transpericardially.…”

Section: En Bloc Double Lung Transplant With Bronchial Artery Revasmentioning

confidence: 99%

“…Given that there are fewer reported bronchial anastomotic complications with bilateral sequential transplants compared to the feared tracheal anastomotic healing complications initially seen in the classic en bloc technique when looking at all age groups, surgeons have shown a clear preference for bilateral sequential transplantation in the modern era. Unlike in adults, the incidence of bronchial stenosis among infants transplanted with the bilateral sequential technique is high 20 . When paired with BAR, the en bloc technique may additionally result in a lower observed rate of bronchiolitis obliterans syndrome compared to those without BAR 20 .…”

Section: Surgical Preoperative Considerationsmentioning

confidence: 99%

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Surgical considerations in infant lung transplantation: Challenges and opportunities

Costello¹,

Carvajal²,

Abarbanell³

et al. 2021

American Journal of Transplantation

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Lung transplantation continues to be a valuable tool for the management of end-stage lung disease, including in infants and children. Although the utility of this therapy is well established, its use is not uniform across the full spectrum of pediatric patients. This variability is particularly noticeable when looking at utilization differences among the separate pediatric and infant patient populations. 1 In addition to variability in rates of use, the technique employed when performing these transplants has differed considerably between centers and eras. Pediatric lung transplantation and infant lung transplantation, in particular, are limited by very small numbers annually in the current era. In 2016, only six infant lung transplants and eight lung procurements from donors younger than 1 year of age were performed worldwide. 2 In addition, the underlying causes of lung failure in infants differ from those in older pediatric patients. Unlike older children, who primarily undergo transplant due to cystic fibrosis, 3 the major indications for lung transplantation in infants are surfactant protein deficiencies, congenital heart disease, and idiopathic pulmonary arterial hypertension. 3,4 Overall, survival for infants undergoing lung transplant is similar to that for older children, 1 although few data are available regarding outcomes for less common diagnoses. For instance, in the case of transplantation for pulmonary hypoplasia due to congenital diaphragmatic hernia, a single case series consisting of three patients has been published, in which only one infant survived to discharge. 5 Consequently, infants undergoing lung transplantation present unique challenges in their preoperative management and surgical approach. We sought to review the current approaches for bridging infants to lung transplantation, surgical techniques utilized, and postoperative outcomes, as well as to highlight areas for further research.

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Interstitial lung disease as an indication for pediatric lung transplant

Kuklinski,

Blatter

2023

Pediatric Pulmonology

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Interstitial lung disease can be an indication for lung transplant at any age, but it is a particularly common indication for lung transplant in infants. Nevertheless, not all interstitial lung diseases will lead to lung transplant in childhood. Genetic testing has aided the identification of these diseases in children. In severely affected patients, however, definitive diagnosis is not always necessary to consider referral to a transplant center. At experienced transplant centers, a multidisciplinary team educates patient families and aids in the transplant evaluation of children with interstitial lung disease. Children who have undergone transplant require lifetime immunosuppression and close surveillance, but can enjoy good quality of life for years following surgery.

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Bronchial artery revascularization and en bloc lung transplant in children

Cited by 31 publications

References 21 publications

ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics

ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics

Surgical considerations in infant lung transplantation: Challenges and opportunities

Interstitial lung disease as an indication for pediatric lung transplant

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