Lung transplantation
Pediatric Lung Transplantation

https://doi.org/10.1016/j.transproceed.2005.02.005Get rights and content

Abstract

Introduction

Pediatric lung transplantation (LT) was started in Spain in 1996 at our institution. We compare the results of pediatric LT with those in adult patients.

Methods

A retrospective review of LT patients from 1993 to 2003 included demographic donor and recipient data, pulmonary function, gas exchange parameters, complications, episodes of rejection and pneumonia, as well as survival. Patients were divided into 2 groups: pediatric (<16 years) and adult (>16 years) LT patients.

Results

Of 165 LTs performed, 23 recipients were pediatric patients (10 boys, 13 girls; mean age, 11.9 ± 2.9 years [range, 5–16 years]). The indications were cystic fibrosis (n = 21), pulmonary fibrosis (n = 1), and Kartagener syndrome (n = 1). The actuarial survival rate was 73%, 67%, and 62% at 1, 3, and 8 years post-LT in children, versus 67%, 56%, and 41% at 1, 3, and 8 years post-LT in adult patients (P = NS). Of the pediatric patients, 35% required mechanical ventilation preoperatively (P < .001). Pediatric patients showed a higher incidence of pneumonia (P < .01) and acute rejection episodes (P = .02) during the first month post-LT, and longer stays in the intensive care unit (P = .02). Pediatric patients displayed more immunosuppression-related adverse effects: diabetes (P = .04), neuropathy (P < .01), and hirsutism (P < .001). In children, arterial oxygen tension improved, from 51 mm Hg pre-LT to 93 mm Hg at 5 years post-LT. Forced expiratory volume in 1 second improved from 28% pre-LT to 84% at 5 years post-LT.

Conclusion

In children, LT is a high-risk procedure because of the critical status of these patients. However, the results of pediatric LT are similar to those in adults, but with better long-term survival.

Section snippets

Patients and methods

From October 1993 to December 2003, 165 patients underwent LT, including 23 children younger than 16 years (study group). The indications for LT in the pediatric population were cystic fibrosis in 21 patients, pulmonary fibrosis in 1, and Kartagener syndrome in 1. The donor selection criteria followed those generally accepted for adult patients (age younger than 55 years, normal chest x-ray film, oxygenation index (arterial oxygen tension/forced inspiratory oxygen [Pao2/Fio2]) greater than 300

Results

Twenty-three children younger than 16 years received LTs during the study period, including 10 boys and 13 girls, with mean age 11.9 ± 2.9 years (range, 5–16), compared with 142 concurrent adult LT patients. The actuarial survival rates of pediatric versus adult LT patients were not significantly different; 8-year survival rate was 62% in children, versus 41% in adults (Fig 1). In children the causes of post-LT death were cardiac failure in 4 cases, bronchiolitis in 2, non-cytomegalovirus

Discussion

From the inception of our Lung Transplant Program in October 1993, to September 2003, we have transplanted lungs in 165 patients, with excellent results. The outcomes of our initial experience with LT have been reported previously.7 Since then, 23 children have received transplants. Pediatric LT recipients as a whole are probably at higher risk, based on their pretransplantation clinical status and diagnosis. In our experience, children undergoing LT more frequently required cardiopulmonary

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