Prognostic Factors Influencing Survival Rates in Children Following Lung Transplantation

• Published in: Transplantation proceedings Vol. 40; no. 9; pp. 3070 - 3072
• Main Authors: Cano, J.R, Cerezo, F, Algar, F.J, Álvarez, A, Espinosa, D, Moreno, P, Baamonde, C, Salvatierra, A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2008; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Bronchiectasis - surgery; Bronchiolitis Obliterans - surgery; Child; Cystic Fibrosis - surgery; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Humans; Kartagener Syndrome - surgery; Lung Transplantation - mortality; Lung Transplantation - physiology; Medical sciences; Pulmonary Fibrosis - etiology; Pulmonary Fibrosis - surgery; Radiotherapy - adverse effects; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Survivors; Time Factors; Tissue Donors - statistics & numerical data; Tissue, organ and graft immunology; Human; Prognosis; Lung; Rate; Transplantation; Homotransplantation; Respiratory system; Survival; Medicine; Treatment; Surgery; Graft; Child
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.09.024

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