Related Experiment Videos
Paediatric incidence of acute rejection and obliterative bronchiolitis: a comparison with adults
J P Scott1, B Whitehead, M de Leval
1Division of Thoracic Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Children face a higher risk of death from obliterative bronchiolitis (OB) after heart-lung transplantation compared to adults. This study found OB risk factors were more prevalent in pediatric patients, leading to increased mortality.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- Obliterative bronchiolitis (OB) is a significant cause of death post-heart-lung transplant.
- Understanding OB risk factors and outcomes in different age groups is crucial for improving patient survival.
Purpose of the Study:
- To compare the incidence of death from OB in pediatric versus adult heart-lung transplant recipients.
- To identify risk factors associated with OB in children post-transplant.
Main Methods:
- Retrospective comparison of 19 children and 72 adults undergoing heart-lung transplantation.
- Analysis of mortality rates due to OB at 2 years post-transplant.
- Evaluation of acute and persistent lung rejection as risk factors and assessment of lung function (FEV1).
Main Results:
- The 2-year incidence of death from OB was significantly higher in children (38%) than in adults (17%).
- Acute and persistent lung rejection were more frequent in children (P = 0.004 and P = 0.001, respectively).
- Children exhibited lower average forced expiratory volume in 1 second (FEV1) post-transplant compared to adults (P < 0.001).
Conclusions:
- Children experience a greater risk of mortality from obliterative bronchiolitis following heart-lung transplantation.
- Increased frequency of rejection episodes and poorer lung function contribute to the higher OB risk in pediatric recipients.
Abstract:
Obliterative bronchiolitis (OB) continues to be a major cause of morbidity and mortality following heart-lung transplantation. We compared the incidence of death from obliterative bronchiolitis in 19 children and 72 adults following heart-lung transplantation at our institutes. The incidence of death from OB at 2 years was 38% for children compared with 17% for adults, this difference was significant (Cox-Mantel Z value = 2.243, P < 0.05). The frequency of acute lung rejection and persistent lung rejection, previously described as risk factors for OB in adults, were significantly more common in children, P = 0.004 and P = 0.001, respectively. Average forced expiratory volume in 1 s was lower in children than in adults for each 3-month period after transplantation (P < 0.001). In conclusion, identified risk factors for the development of OB were more common, and the risk of death from OB was greater in children than in adults following heart-lung transplantation.