Pediatric lung transplantation at St. Louis Children's Hospital, 1990- 1995

Stuart C. Sweet, Thomas L. Spray, Charles B. Huddleston, Eric Mendeloff, Charles E. Canter, David T. Balzer, Nancy D. Bridges, Alan H. Cohen, George B. Mallory

Research output: Contribution to journalArticle

Abstract

Although accepted therapy in adults, lung transplantation in children is less well established. Reports from the few existing pediatric centers have involved relatively small patient number. Seventy-nine patients underwent 88 lung transplant procedures at St. Louis Children's Hospital between June 1990 and August 1995. Twenty-one transplants (24%) were done in 19 infants and children under the age of 3 yr. Twelve-, 24-, and 48-mo actuarial survival for the primary transplants was 69%, 67%, and 60%, respectively. Survival improved over the course of the program: 12-mo survival for patients transplanted during the first 18 mo was 42% compared with 78% for those transplanted after December 1991. Survival of children transplanted at younger than 3 yr of age was comparable to older children and adults. However, younger children had a lower incidence of acute rejection; none developed bronchiolitis obliterans. Both graft growth and linear growth occurred. Risk factors for early mortality included presence of aortopulmonary collateral vessels and prior thoracic surgery. Risk factors for survival duration included requiring assisted ventilation at the time of transplant, continuous supplemental oxygen requirement, and presence of aortopulmonary collateral vessels. The major late complication was bronchiolitis obliterans, which occurred in 27% of patients and played a role in 64% of late deaths. Investigation of the lower incidence of acute rejection and bronchiolitis obliterans in younger versus older children may reveal important information about the etiology of this disease. The ultimate long-term success of lung transplantation will depend on identification and treatment of the mechanisms responsible. A multicenter data registry would facilitate further clinical studies of pediatric lung transplantation.

Original languageEnglish (US)
Pages (from-to)1027-1035
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume155
Issue number3
StatePublished - 1997
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Sweet, S. C., Spray, T. L., Huddleston, C. B., Mendeloff, E., Canter, C. E., Balzer, D. T., Bridges, N. D., Cohen, A. H., & Mallory, G. B. (1997). Pediatric lung transplantation at St. Louis Children's Hospital, 1990- 1995. American Journal of Respiratory and Critical Care Medicine, 155(3), 1027-1035.