Living-donor single-lobe lung transplant in a 6-year-old girl after 7-month mechanical ventilator support

Abstract

CLINICAL SUMMARY A 6-year-old girl had Stevens–Johnson syndrome diagnosed after receiving oral medication for an upper respiratory tract infection. She was treated with corticosteroids but required mechanical ventilation on July 7, 2007. Under intensive care, she was extubated on July 18, 2006. Although there was a gradual improvement in her skin lesions, her respiratory status worsened again, and a diagnosis of bronchiolitis obliterans was made. She was reintubated on November 13, 2007. The patient was transferred to Kyoto University Hospital on May 21, 2008. On admission, she was receiving mechanical ventilation through a tracheostomy. The ventilator setting was synchronous intermittent mandatory ventilation mode with a frequency of 10 breaths/min, pressure control of 26 cm H2O, and pressure support of 26 cm H2O. Arterial blood gas measurement with this setting (inspired oxygen fraction 0.3) revealed a pH of 7.33, arterial PO2 of 88.6 mm Hg, and arterial PCO2 of 62.3 mm Hg. the patient’s spontaneous respiratory rate was 30 to 35 breaths/min, and her own respiratory effort was preserved. Cadaveric lung transplant was not a realistic option, because in Japan brain death is accepted only for potential donors older than 15 years. The patient’s mother, 35 years old, was the only available living donor in her family. The surgical options were discussed with the family, and they were willing to proceed with living-donor single-lobe lung transplant, which they understood to be still an experimental procedure. The respective heights and weights were 113 cm and 16.0 kg for the recipient and 160 cm and 58.0 kg for the donor. The estimated forced vital capacity of the graft