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Lung transplantation in infants and toddlers from 1990 to 2004 at St. Louis Children's Hospital
A Elizur1, A Faro, C B Huddleston
1Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA.
Insights
Lung transplantation in young children shows comparable survival rates to older patients. Infants and toddlers experienced less acute rejection and fewer cases of bronchiolitis obliterans post-transplant.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Transplantation immunology
Background:
- Lung transplantation outcomes vary significantly by age group.
- Data on infant and toddler lung transplant recipients is limited.
- Understanding age-specific challenges is crucial for optimizing post-transplant care.
Purpose of the Study:
- To compare lung transplant outcomes in infants and toddlers versus older children.
- To evaluate graft survival, rejection rates, and functional recovery across age groups.
- To identify unique challenges and potential immunologic factors in pediatric lung transplantation.
Main Methods:
- Retrospective, single-center cohort study.
- Comparison of 109 lung transplants performed between 1990-2004.
- Exclusion of specific conditions like cystic fibrosis and re-transplantations.
Main Results:
- Graft survival was similar across age groups (infants, toddlers, >3 years) at 1 and 3 years post-transplant.
- Infants and toddlers had significantly lower rates of acute rejection and bronchiolitis obliterans.
- Most young recipients showed minimal lung function impairment and near-normal development, but depressed somatic growth persisted at 5 years.
Conclusions:
- Lung transplantation in infants and young children yields survival rates comparable to older children and adults.
- Younger recipients demonstrate improved outcomes regarding acute and chronic rejection.
- Further research into immunologic differences may inform strategies to prevent rejection in all lung transplant patients.
Abstract:
In a retrospective, single-center cohort study, outcomes of infants and toddlers undergoing lung transplant at St. Louis Children's Hospital between 1990 and 2004 were compared to older children. Patients with cystic fibrosis (exclusively older children) and those who underwent heart-lung, liver-lung, single lung or a second transplantation were excluded from comparisons. One hundred nine lung transplants were compared. Thirty-six were in infants <1 year old, 26 in toddlers 1-3 years old and 47 in children >3 years old. Graft survival was similar for infants and toddlers (p = 0.35 and p = 0.3, respectively) compared to children over 3 years old at 1 and 3 years after transplant. Significantly more infants (p < 0.0001 and p = 0.003) and toddlers (p = 0.002 and p = 0.03) were free from acute rejection and bronchiolitis obliterans compared to older patients. While most infants and toddlers had only minimal lung function impairment, and achieved normal to mildly delayed developmental scores, somatic growth remained depressed 5 years after transplant. Lung transplantation in infants and young children carries similar survival rates to older children and adults. Further insights into the unique immunologic aspects of this group of patients may elucidate strategies to prevent acute and chronic rejection in all age groups.
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