RESUMO
Background: Acute rejection after transplantation occurs as a result of complex immune responses following the detection of the major histocompatibility complex of the donors in recipients. As one of the risk factors of chronic rejection, acute rejection can directly lead to death. Therefore, early prevention and monitoring of transplant patients is critical. Pediatric acute rejection after lung transplantation is relatively rare compared to adults, and it remains a considerable challenge since information on rare primary disease complicated by acute rejection after lung transplantation in children is extremely limited, with only a single case series reported in the literature. Case Description: Here, we present a case of a 10-year-old female diagnosed with severe interstitial pneumonia, pulmonary heart disease and severe malnutrition. The patient underwent double-lung transplantation under general anesthesia. Through monitoring and management of immunosuppressants, prevention and control of infection, dynamic body fluid management, personalized nutritional support, psychological care and rehabilitation exercises, the patient achieved recovery and was safely discharged after 21 days. Conclusions: Characteristics of acute rejection after lung transplantation in children include rapid onset and progression of respiratory distress, significant difficulty in nursing and frustration in communication. Anti-infection, anti-rejection, and symptomatic measures in the acute phase are critical in controlling disease progression and improving prognosis.
RESUMO
BACKGROUND: The purpose of this study was to uncover preoperative risk factors for extubation failure or re-intubation for patients undergoing lung transplant (LTx). METHODS: We performed a retrospective case-control study of LTx from our center between January 2017 and March 2019. Demographic and preoperative characteristics were collected for all included patients. Univariable analysis and multivariable logistic regression were used to analyze risk factors of postoperative unsuccessful extubation following LTx. RESULTS: Among 107 patients undergoing first LTx investigated, 74 (69.16%) patients who were successfully liberated from mechanical ventilation (MV), and 33 (30.84%) patients who were unsuccessful extubation, which 18 (16.82%) patients suffered from reintubation. associated preoperative factors for unsuccessful extubation following LTx included preoperative extracorporeal membrane oxygenation (ECMO) support [OR =4.631, 95% confidence interval (CI): 1.403-15.286, P=0.012], the preoperative ability of independent expectoration (OR =4.517, 95% CI: 1.498-13.625, P=0.007), the age older than 65-year-old (OR =4.039, 95% CI: 1.154-14.139, P=0.029), and receiving the double lung and heart-LTx (OR =3.390, 95% CI: 0.873-13.162, P=0.078; and OR =16.579, 95% CI: 2.586-106.287, P=0.012, respectively). Further, we investigated the preoperative predicted factors for reintubation. Only the preoperative ECMO remained a significant predictor of re-intubation (OR =4.69, 95% CI: 1.56-15.286, P=0.012). CONCLUSIONS: Preoperative independent sputum clearance, preoperative ECMO, older than 65-year-old, and double lung or heart-LTx were four independent risk factors for unsuccessful extubation. Moreover, preoperative ECMO was the only independent risk factor for reintubation.
