Article

Two decades of pediatric lung transplant in the United States: Have we improved?

Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, Tex 77030, USA.
The Journal of thoracic and cardiovascular surgery (Impact Factor: 4.17). 03/2011; 141(3):828-32, 832.e1. DOI: 10.1016/j.jtcvs.2010.06.067
Source: PubMed

ABSTRACT

Since 1988, approximately 1100 pediatric lung transplants have been performed worldwide with consistent improvement in survival. Similarly, survival for pediatric heart transplant has increased over the years; however, in this cohort improvement in survival is exclusively a result of increased early (1-year) survival. To observe if this same phenomenon exists in pediatric lung transplants, the United Network for Organ Sharing database was analyzed to evaluate and characterize how pediatric lung transplant survival has changed in the past 2 decades.
The United Network for Organ Sharing database was queried for patients aged 18 years or less who underwent lung transplantation from May 1988 to May 2008. Analysis included 959 pediatric lung transplants.
Age groups were infants (≤1 years) (n = 106 [11%]), children (2-12 years) (n = 299 [31%]), and adolescents (≥13 years) (n = 554 [58%]). A total of 546 (57%) were girls. Kaplan-Meier survival was significantly better in the late era (2002-2008) than in all other eras (1988-1994 and 1995-2001) (P < .05). The half-life for graft has increased significantly over the eras (early, 2.2 years; mid, 3.3 years; and late, 3.8 years). Conditional 1-year survival (ie, mid to late survival) was not significantly different (P = .3) among the eras. Gender, age, diagnosis, prolonged ischemic time, and cytomegalovirus mismatch did not significantly affect overall patient or graft survival. Chronic preoperative steroid dependence (P = .02), preoperative ventilatory dependence (P < .001), and retransplantation (P = .02) were associated with decreased survival.
Survival in pediatric lung transplant has increased significantly over the years, but this improvement primarily reflects improvement in early survival. Survival in pediatric lung transplant after the first posttransplant year has not changed in more than 2 decades.

Download full-text

Full-text

Available from: Farhan Zafar, Apr 07, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lung transplantation has evolved as an accepted therapy in carefully selected children with end-stage lung disease, offering a prolonged survival and improved quality of life. Presently, more than 100 lung transplant procedures are done in children annually worldwide. Specific aspects of children and adolescents undergoing lung transplantation will be reviewed and an update on most recent developments in the management of paediatric lung transplant recipients will be given. Certain aspects are unique to children and adolescents undergoing lung transplantation such as a challenging surgical procedure, the effects of immunosuppressant therapy, and the impact of infections on the child's developing immune system and somatic growth. The underlying diagnoses leading to lung transplantation vary considerably by age group. Early referral, careful patient selection and appropriate timing of listing are crucial to achieve the maximal survival benefit. In particular, infectious complications are a common in children. Chronic lung allograft dysfunction remains the major obstacle for a better long-term survival. Lung transplantation has successfully been performed in infants, children and adolescents with outcomes similar to that in adults. Specific aspects of paediatric lung transplantation include donor shortage for smaller recipients, somatic growth, psychosocial aspects and adherence, and transition to adult care.
    No preview · Article · Aug 2012 · Current opinion in organ transplantation
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: There have been >1,600 pediatric lung transplantations (LTx) performed worldwide with a trend toward improved outcomes over the last 25 years. The majority of these LTxs have been in older children and adolescents. Less than 4 infant (defined as≤12 months of age) LTxs per year have been performed over the past 20 years, mostly in the USA. However, infant LTx outcomes have not been well documented in a multi-institutional longitudinal fashion. METHODS: The United Network of Organ Sharing database was queried from October 1987 to July 2011. Of the 1,003 pediatric LTxs reported, 84 (8%) were infants. All combined transplantations were excluded. RESULTS: Eighty-one infants received 84 LTxs, of which 95% had a bilateral LTx. Median age and weight at LTx was 4 months (range 0 to 11 months) and 5.3 kg (2.7 to 11.8 kg), respectively. Median ischemic time was 5.2 hours (2.0 to 10.8 hours). Overall Kaplan-Meier graft survival was similar for infants compared with other pediatric age group (OPA: >1 to 18 years) LTx recipients (half-life 4.0 years vs 3.4 years, p = 0.7). Conditional 1-year graft survival for infants was significantly higher than OPA (half-life 7.4 years vs 5.0 years, p = 0.024). Early (1987 to 2000, n = 46) and late (2001 to 2011, n = 38) era graft survival was not significantly different. Graft survival in pre-LTx ventilated infants was significantly better than pre-LTx ventilated OPA (half-life 6.1 years vs 0.9 year, p = 0.004) and was not statistically different from pre-LTx infants not on ventilatory support (half-life 6.1 years vs 2.2 years, p = 0.152). Cox regression of 5 variables (weight, donor arterial PO(2), pre-Tx ventilator, organ ischemic time, center experience) showed that survival was associated with increased center experience (p = 0.03). CONCLUSION: Infants undergoing LTx have outcomes similar to those of all other pediatric LTx patients.
    Full-text · Article · Nov 2012 · The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lung transplantation has become an accepted therapeutic option for children with end-stage lung disease. Advances have been made over the last 2 decades in lung transplantation concerning the procurement and preservation of donor lung, surgical techniques, early post-operative care and immunosuppression. The pediatric lung transplant program at Hospital Universitari Vall d'Hebron was started in 1996. A total of 672 lung transplants have been performed in our hospital since 1990, with 51 (7.6%) corresponding to children (younger than 18 years). Cystic fibrosis is the leading cause for pediatric patients to require lung transplantation. In our hospital cystic fibrosis represent only 8.7% of lung transplants in children less than 11 years-old, but 86% in children 12-17 years old. Other important indications for lung transplantation in children are pediatric forms of interstitial lung diseases and pulmonary vascular disorders (mainly pulmonary hypertension). Actuarial survival is our center (55% at 5 years and 47% at 7 years) is similar to survival published in the International Registry.
    No preview · Article · Nov 2013 · Revista española de pediatría
Show more