Long-term clinical follow-up after lung transplantation in patient with scoliosis: a case report
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CASE REPORT
Long‑term clinical follow‑up after lung transplantation in patient with scoliosis: a case report Haruchika Yamamoto1 · Shinji Otani1 · Kentaroh Miyoshi1 · Seiichiro Sugimoto1 · Masaomi Yamane1 · Shinichi Toyooka1 Received: 2 October 2020 / Accepted: 23 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Severe scoliosis causes anatomical distortion of structures in the chest, which raises concerns about donor-recipient sizemismatch in lung transplantation (LT), so that severe scoliosis is considered as an absolute contraindication for LT. Also, postoperative right-side bronchial stenosis is one of the common complications in LT recipients with severe scoliosis. To date, the long-term outcomes in severe scoliosis patients with bronchial stenosis after LT have not been reported. A 14-year-old female patient with scoliosis and interstitial pneumonia underwent bilateral cadaveric LT. Although she developed bronchial stenosis post-LT, necessitating bronchoscopic intervention on three occasions, her lung function and perfusion recovered to the levels recorded prior to development of the obstruction, with the good condition maintained for more than 5 years after the LT. Therefore, while patients with severe scoliosis are at an elevated risk of postoperative transient bronchial stenosis, scoliosis should not always be considered as a contraindication to LT. Keywords Scoliosis · Lung transplantation · Long-term follow-up · Surgery · Bronchial stenosis Abbreviations LT Lung transplantation CPB Cardiopulmonary bypass
Introduction Lung transplantation (LT) in patients with severe scoliosis can cause severe pulmonary restriction due to chest wall distortion, and a reduced chest volume for LT. Therefore, significant spinal and chest wall deformity is regarded as an absolute contraindication to LT [1, 2]. However, to date, several cases of LT in patients with scoliosis have been reported, with acceptable results [1, 3, 4]. In LT recipients with severe scoliosis, postoperative “right-side” bronchial stenosis is one of the common complications [1, 3]. However, the long-term outcomes in patients with this complication have not yet been reported. This case report describes * Shinji Otani s‑ohtani@okayama‑u.ac.jp 1
Okayama University Hospital, Department of General Thoracic Surgery and Organ Transplant Center, 2‑5‑1 Shikata‑cho, Kita‑ku, Okayama‑city, Okayama 700‑8558, Japan
a patient with scoliosis who underwent LT and developed postoperative bronchial stenosis, in whom we monitored the serial changes in lung function and perfusion for more than 5 years.
Case A 14-year-old female patient with interstitial pneumonia and secondary pulmonary hypertension, who also has severe scoliosis (Fig. 1), underwent cadaveric bilateral sequential LT. Her Cobb’s angle (defined as the angle between the two vertebrae whose endplates are the most tilted towards each other) was 65 degrees, and the lung volume was 1228 ml on the right side and 756 ml on the left, as assessed by preoperative 3D-CT volumetry
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