Prognostic factors influencing survival rates in children following lung transplantation

To assess the results of lung transplantation (LT) in children under 17 years of age and identify factors affecting long-term survival.

A retrospective review was performed of 37 patients (<17 years) who had received a lung transplant between 1996 and 2007. Morbidity, mortality, and survival were analyzed by the Kaplan-Meier method and the log-rank test.

There were 37 LTs: 30 bilateral, four lobar, two liver-lung, one unilateral. Indications for transplantation were: cystic fibrosis (n = 30), pulmonary fibrosis (n = 1), bronchiectasis (n = 1), Kartagener's syndrome (n = 1), bronchiolitis obliterans (n = 3), and pulmonary fibrosis due to radiotherapy-chemotherapy (n = 1). The intubation time and oxygenation index of donors were 49 +/- 36 hours and 455 +/- 83.5 mm Hg, respectively. Seventeen patients needed extracorporeal circulation (ECC) and 13 were coded as priorities. High blood pressure and renal failure were the most frequent complications. Overall survival rates were 65.7%, 59.4%, 56.1%, 44.5%, and 39.6% at 1, 2, 3, 5, and 10 years, respectively. Need for ECC (P = .001), surgical complications (P = .037), oxygenation index <450 mm Hg (P = .005), OLT in priority code (P = .04), and age of donor >16 years (P = .005) were associated with poor survival.

LT is an appropriate procedure for certain types of end-stage pediatric pulmonary pathologies, achieving acceptable long-term survival rates. When the procedure is carried out under a surgical priority code, it is associated with a high rate of perioperative morbidity and mortality and poorer long-term survival. Other factors that have a negative influence on survival include the need for ECC, surgical complications, an oxygenation index <450 mm Hg, and donor age >16 years.