Severe scoliosis with an impaired pulmonary allograft function after pediatric unilateral lung transplantation
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CASE REPORT
Severe scoliosis with an impaired pulmonary allograft function after pediatric unilateral lung transplantation Takeshi Shiraishi1 · Haruhisa Yanagida2 · Yuhki Koga3 · Shouichi Ohga3 · Masaki Fujita4 · Masafumi Hiratsuka1 · So Miyahara1 · Ryuichi Waseda1 · Toshihiko Sato1 · Akinori Iwasaki1 Received: 8 June 2020 / Accepted: 19 July 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Left‐unilateral single‐lobe lung transplantation from a living donor was performed in a 4-year-old boy who suffered from severe respiratory failure caused by bronchiolitis obliterans (BO) as a result of graft versus host disease (GVHD) after peripheral blood stem cell transplantation (PBSCT). The patient grew well during his early childhood years, with an excellent lung allograft function. However, severe thoracic scoliosis occurred 7 years after lung transplantation, which ultimately resulted in compression of the lung allograft followed by severe respiratory dysfunction, and the patient became dependent on mechanical ventilation support. Posterior spinal fusion of Th2‐L3 with instrumentation and bone grafting was performed to correct scoliosis in the hope of recovering his thoracic capacity. The left thoracic volume was dramatically improved immediately after spinal fusion surgery, and the patient was ultimately weaned off of mechanical ventilation after a year of pulmonary rehabilitation. Keywords Lung · Transplantation · Unilateral · Pediatric · Scoliosis
Introduction Pediatric lung transplantation has most commonly been performed as bilateral sequential transplantation using size-matched allografts from brain-dead donors. However, in Japan, where extreme brain‐dead donor shortages persist, especially pediatric donors, living donor lung transplantation is still frequently performed as the most realistic option. In standard living donor lung transplantation, the right and left lower lobes from two healthy donors are implanted through bilateral sequential transplantation in place of the recipient’s whole right and left lungs. If the recipient has too small a * Takeshi Shiraishi tshiraishi‑[email protected] 1
Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7‑45‑1, Jonan‑ku, Fukuoka City, Fukuoka 814‑0180, Japan
2
Department of Orthopedic Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
3
Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka, Japan
4
Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
physique to support bilateral lobar transplantation, or if only one compatible donor is available, living‐donor unilateral single lobar lung transplantation is considered [1]. We previously reported a case of living donor lung transplantation in a 4-year-old boy who suffered from severe respiratory failure caused by graft versus host disease (GVHD)‐ induced bronchiolitis obliterans (BO) after peripheral blood stem cell transplantation (PBSCT) [2]. There was no doubt that lung trans
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