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Lung transplantation in children.

Charles B Huddleston1, Jeffrey B Bloch, Stuart C Sweet

  • 1Department of Surgery, Washington University School of Medicine, St. Louis Childrens' Hospital, Missouri 63110, USA. huddlestonc@msnotes.wustl.edu

Annals of Surgery
|August 23, 2002
PubMed
Summary

Pediatric lung transplantation (LTX) offers a viable, though high-risk, treatment for children with end-stage lung disease. Bronchiolitis obliterans remains the primary challenge for long-term survival in these young patients.

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Area of Science:

  • Pediatric Surgery
  • Pulmonology
  • Transplantation Medicine

Background:

  • Pediatric lung transplantation (LTX) presents unique challenges compared to adult procedures, including recipient size, indications, and post-transplant care.
  • This study analyzes the largest series of pediatric lung transplants globally, offering insights into patient selection and outcomes.

Purpose of the Study:

  • To detail the authors' experience with pediatric lung transplantation (LTX).
  • To provide an overview of patient selection criteria and outcomes for pediatric LTX.
  • To identify key factors influencing survival and complications in pediatric lung transplant recipients.

Main Methods:

  • Analysis of 207 isolated lung transplants performed on 190 children under 18 years old from 1990 to the present.

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  • Categorization of patients by age at transplant (under 1, 1-5, 5-10, 10-18 years) and primary diagnosis (cystic fibrosis, pulmonary vascular disease, bronchiolitis obliterans, etc.).
  • Kaplan-Meier survival analysis and assessment of causes of early and late mortality, as well as incidence of post-transplant complications.

    • Main Results:

    • Five-year survival rates for pediatric lung transplantation were 77% at 1 year, 62% at 3 years, and 55% at 5 years.
    • The most common causes of early death were graft failure, while late deaths were primarily due to bronchiolitis obliterans (57%), infection (21%), and posttransplant malignancies (18%).
    • Bronchiolitis obliterans occurred in 46% of long-term survivors, with risk factors including age over 3 years, multiple acute rejection episodes, and prolonged organ ischemic time.

    Conclusions:

    • Pediatric lung transplantation (LTX) is a high-risk but feasible treatment option for children with end-stage pulmonary and vascular diseases.
    • Bronchiolitis obliterans is the principal obstacle to achieving better long-term survival rates in pediatric lung transplant recipients.
    • Further research and management strategies are needed to mitigate the impact of bronchiolitis obliterans and improve outcomes in pediatric LTX.