Outcomes in pediatric lung transplant recipients receiving adult allografts

Clinical practice in the United States has no restrictions in allocating lungs from adult donors to pediatric recipients.

The United Network for Organ Sharing database was queried from 1987 to 2013 for pediatric lung transplant recipients (aged less than 18 years) to assess survival using continuous donor age in years and two donor age groups, ≥ 18 years and > 30 years, for analysis.

Of 930 pediatric lung transplants, basic survival analysis identified a mortality hazard when adult lung allografts were transplanted into pediatric recipients; however, multivariate Cox models demonstrated that continuous donor age (hazard ratio [HR] 1.004, 95% confidence interval [CI]: 0.992-1.015, p = 0.524) as well as both categoric age groups, donor 18 years or older (HR 0.967, 95% CI: 0.714-1.309, p = 0.827) and donor older than 30 years (HR 1.168, 95% CI: 0.815-1.673, p = 0.398), did not significantly influence the risk for death. Moreover, propensity score matching analysis confirmed a lack of association of mortality risk with donor age ≥ 18 years (HR 1.129, 95% CI: 0.696-1.831, p = 0.623) and donor age > 30 years (HR 1.050, 95% CI: 0.569-1.937, p = 0.876). Bronchiolitis obliterans syndrome (BOS) was found to be a significant predictor of mortality in univariate analysis (HR 2.033, 95% CI: 1.639-2.521, p < 0.001), but the hazard of BOS did not vary across donor age categories.

Adult donor lung allografts appear not to negatively affect survival in pediatric lung transplant recipients when considering confounders, and do not influence survival through an increased hazard for the development of BOS.