Photograph by Jennifer Silverberg
Getting an invitation to the high-school graduation of a patient whose lungs were transplanted when he was a toddler is one of the high points of working with some of medicine’s most vulnerable patients. Cardiothoracic surgeons at St. Louis Children’s Hospital, which has the world’s most active pediatric lung transplant program, provide transplantation as an option for children who might not survive cystic fibrosis and other diseases. And the hospital is taking younger patients each year.
Last year, 2-year-old Owen Stark of Eldon, Mo., became the world’s youngest person to receive an artificial lung after being diagnosed with idiopathic pulmonary arterial hypertension—an extremely rare condition for a child his age. Doctors petitioned the U.S. Food and Drug Administration to implant the German-developed Novalung sLA artificial lung (not yet FDA-approved in the U.S. at the time) until Owen’s organs were ready for the stress of a transplant. When it came time to remove the device, however, doctors discovered the young boy’s lung function had dramatically improved, and he was taken off the transplant list.
Then, this June, Ronan Bush of Wellston, Mich., became the first infant to use an artificial lung as a bridge to a lung transplant.
Dr. Pirooz Eghtesady, director of cardiothoracic surgery, says the hospital’s team of physicians is always thinking of creative solutions in order to save lives. During the past year, St. Louis Children’s Hospital has performed about 30 heart transplants, 15 lung transplants, and hundreds of open-heart surgeries on children; its biggest area of growth is transplants of lungs in infants with congenital diseases.
Intensive surgeries on infants and children are more complicated than working on adults. Children—especially infants who haven’t yet developed immunities—face a higher risk of infection, says Dr. Stuart Sweet, who leads the hospital’s pediatric lung-transplant program.
Another challenge is related to growth—some transplanted lungs don’t develop as quickly as the child. “We have to put in a set of lungs that match the size of the patient, but we hope they grow to normal size,” says Sweet. “Some children don’t survive, but now every week I see someone who has survived for more than 10 years.”
Advances in technology mean children around the world have the hope of living longer. The hospital takes on desperate patients and special cases from outside of the U.S. “We’ve transplanted two patients from the Middle East in the last six months,” says Sweet. “The reason that we’re willing to accept candidates from that far away is that these kids don’t have any other options. We’re looking to help patients who don’t have options.”
