Successful bilateral lung transplantation and simultaneous Nuss technique correction of pectus excavatum post-allogeneic haematopoietic stem cell transplantation

Abstract

Bronchiolitis obliterans syndrome after allogeneic haematopoietic stem cell transplantation has aroused clinical concern. We describe a case of a 39-year-old female patient diagnosed as bronchiolitis obliterans syndrome and concomitant pectus excavatum with a Haller index of 3.32. The patient received bilateral lung transplantation and simultaneously underwent Nuss surgery via bilateral anterolateral thoracotomies with veno-arterial extracorporeal membrane oxygenation support. The bar was removed 2 years after transplantation, and the patient has been stable in the past 4 years with haematological remission and satisfactory lung function.

Simultaneous pectus excavatum correction and lung transplantation–A case series

“…3 The second report was published by a Chinese group in 2019, using a similar technique in a symmetric pectus patient requiring lung transplantation for graft-versus-host disease. 7 The reported series herein extends these 2 cases by reporting 3 cases including (1) 2 pediatric transplantations, (2) 1 bilobar transplantation, and (3) 2 modified Ravitch procedures instead of a simple Nuss procedure ( Table 1).…”

“…In a report published in 2018 by Aigner and colleagues, a symmetric pectus excavatum in a 38‐year‐old fibrosis patient was corrected after a bilateral lung transplantation with a Nuss bar, which was inserted to lift the sternum through 2 anterior thoracotomies 3 . The second report was published by a Chinese group in 2019, using a similar technique in a symmetric pectus patient requiring lung transplantation for graft‐versus‐host disease 7 . The reported series herein extends these 2 cases by reporting 3 cases including (1) 2 pediatric transplantations, (2) 1 bilobar transplantation, and (3) 2 modified Ravitch procedures instead of a simple Nuss procedure (Table 1).…”

Bilateral sequential lung transplantation: technical aspects

“…In addition to concerns for donor-recipient size mismatch and restrictive chest wall compliance which may affect graft function (42,43), chest wall deformities may complicate positioning of the patient during the procedure as well as exposure. Hence, only a few cases of LTx in patients with chest wall deformities are reported (42)(43)(44)(45). Our group has reported two cases of bilateral LTx in patients with severe scoliosis, one through clamshell incision and the second through sternotomy (42).…”

“…Notably, the second case had right-sided airway narrowing secondary to compression by scoliotic spine but did not require intervention. Two groups reported simultaneous bilateral LTx and pectus excavatum repair using the Nuss technique (43,45). The surgical approach was bilateral anterolateral thoracotomies in both cases.…”

Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement

“…99 Given that paediatric long-term survivors of HCT might be candidates for lung transplantation, the panel strongly agreed that ECMO may be used as a bridge to lung transplantation in long-term survivors with acute on chronic respiratory failure due to bronchiolitis obliterans". [100][101][102][103][104]…”