Abstract and Introduction
Abstract
In a retrospective, single-center cohort study, outcomes of infants and toddlers undergoing lung transplant at St. Louis Children's Hospital between 1990 and 2004 were compared to older children. Patients with cystic fibrosis (exclusively older children) and those who underwent heart-lung, liver-lung, single lung or a second transplantation were excluded from comparisons. One hundred nine lung transplants were compared. Thirty-six were in infants < 1 year old, 26 in toddlers 1-3 years old and 47 in children > 3 years old. Graft survival was similar for infants and toddlers (p = 0.35 and p = 0.3, respectively) compared to children over 3 years old at 1 and 3 years after transplant. Significantly more infants (p < 0.0001 and p = 0.003) and toddlers (p = 0.002 and p = 0.03) were free from acute rejection and bronchiolitis obliterans compared to older patients. While most infants and toddlers had only minimal lung function impairment, and achieved normal to mildly delayed developmental scores, somatic growth remained depressed 5 years after transplant. Lung transplantation in infants and young children carries similar survival rates to older children and adults. Further insights into the unique immunologic aspects of this group of patients may elucidate strategies to prevent acute and chronic rejection in all age groups.
Introduction
Lung transplantation is the only intervention available for a variety of end-stage lung diseases in children. Infants and toddlers comprise distinctive groups within pediatric lung transplantation, both in diagnoses leading to transplantation and in posttransplant complications, and thus deserve special consideration. However, the only literature addressing this group of patients is registry data, with its inherent limitations. We describe 15 years (from 1990 to 2004) of experience with lung transplantation in children under the age of 3 years and also compare that experience to children transplanted after the age of 3 years at St. Louis Children's Hospital with a follow-up ranging from 1 day to 14.5 years.