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High-risk age window for mortality in children with cystic fibrosis after lung transplantation

Don Hayes1, Karen S McCoy, Bryan A Whitson

  • 1Department of Pediatrics, The Ohio State University, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.

Pediatric Transplantation
|November 29, 2014
PubMed

Insights

Lung transplantation (LTx) for cystic fibrosis (CF) in children shows the highest mortality risk between ages 16-20. Survival improves significantly after this critical age window, suggesting optimized post-transplant care timing may be beneficial.

Area of Science:

  • Pediatric Pulmonology
  • Transplant Surgery
  • Biostatistics

Background:

  • Lung transplantation (LTx) in pediatric patients with cystic fibrosis (CF) presents unique challenges and remains a topic of debate.
  • Understanding post-transplant mortality risk is crucial for optimizing outcomes in this vulnerable population.

Purpose of the Study:

  • To identify the age-specific hazard of mortality in children with CF following lung transplantation.
  • To determine if there is a specific age window associated with the highest risk of post-transplant mortality.

Main Methods:

  • Analysis of the United Network for Organ Sharing (UNOS) database from 1987 to 2013.
  • Inclusion of pediatric CF patients (<18 years at transplant) in survival analysis (n=489).
  • Application of the Proportional Hazards Cox Regression (PCHR) model to quantify mortality risk over attained age.

Main Results:

  • The highest hazard of post-transplant mortality was observed in pediatric CF patients between 16 and 20 years of attained age.
  • A statistically significant decline in the hazard of mortality was noted immediately following this high-risk age window (HR=0.394, p=0.004).
  • This decline in mortality risk persisted even after adjusting for potential confounding factors.

Conclusions:

  • Mortality risk following lung transplantation in children with CF is significantly elevated between 16 and 20 years of age.
  • Outcomes appear to improve after this critical age period, suggesting a potential benefit from timing interventions or closer monitoring during this phase.
  • These findings have implications for managing pediatric CF patients undergoing LTx and highlight the importance of age-specific risk stratification.

Keywords:
ageallograft failurecystic fibrosislung transplantationsurvival

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