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Bilateral lung transplantation (BLTx) in a 9-year-old girl with bronchopulmonary dysplasia with pulmonary hypertension
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  • Chiharu Ota,
  • Ryoko Saito,
  • Junya Tominaga,
  • Shinya Iwasawa,
  • Hirama Takashi,
  • Yasushi Matsuda,
  • Katsunori Ono,
  • Takehiko Onoki,
  • Masato Kimura,
  • Yoshinori Kawabata,
  • Yoshinori Okada
Chiharu Ota
Tohoku University Hospital

Corresponding Author:chiharu.ota.e8@tohoku.ac.jp

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Ryoko Saito
Tohoku University Graduate School of Medicine
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Junya Tominaga
Tohoku University Hospital
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Shinya Iwasawa
Tohoku University Hospital
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Hirama Takashi
Tohoku University Hospital
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Yasushi Matsuda
Tohoku University Hospital
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Katsunori Ono
Tohoku University Hospital
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Takehiko Onoki
Tohoku University Hospital
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Masato Kimura
Miyagi Children's Hospital
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Yoshinori Kawabata
Saitama Cardiovascular and Respiratory Center
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Yoshinori Okada
Tohoku University Hospital
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Abstract

Background Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease that occurs in premature infants and the prognosis is variable depending on the comorbidities including fibrosis, emphysema, or pulmonary hypertension (PH). We present a case of a 9-year-old girl who developed PH associated with severe BPD (BPD-PH) and underwent bilateral lung transplantation (BLTx). Case description A 9-year-old girl admitted to our department to undergo BLTx. She was born at 23 weeks and 4 days gestation with a weight of 507 grams. She received ventilation for the first 2 months and required further respiratory care due to repetitive, severe respiratory infections. She was diagnosed with BPD-PH at 6 months of age and oral administration of pulmonary vasodilators were initiated. She was registered as a lung transplant candidate at 4 years of age after the life-threatening exacerbation. Chest computed tomography (CT) revealed severe lung conditions with ground-glass opacities and emphysematous low-density areas in the upper and lower lobes. BLTx from a brain-dead male donor was performed. The pathological findings of her resected lung revealed saccular, hypoplastic lung with alveolar repair/regeneration and medial hypertrophy and muscularization of peripheral arteries. The postoperative course was mostly uneventful. She was free from oxygen administration and showed no signs of PH after 6 months of the surgery. Conclusion This is the first case report of BLTx in a pediatric, irreversible BPH-PH patient with detailed pathohistological findings and clinical examination. Lung transplantation is one of the treatment options for severe BPD-PH.