Long Term Outcome After Pediatric Lung Transplantation

Abstract

<h3>Purpose</h3> Pediatric lung transplantation is an infrequent, but potentially life-saving procedure for patients with end-stage pulmonary disease. While survival has been increasing over the last decades, there is a lack of data regarding long-term survivors after pediatric lung. The Vienna transplant center is unique in having a high re-transplant rate in children, leading to a high median overall survival with a large number of long-term survivors. Aim of the present retrospective single-center study was to describe the post-transplant organ function, survival, medical complications and social status of patients that survived at least 5 years after lung transplantation in pediatric age. <h3>Methods</h3> Long term outcome of 30 pediatric lung transplant recipients was assessed retrospectively. Primary outcome contained medical status five years after transplantation (growth, BMI, lung function), complications (osteopenia, diabetes mellitus, post-transplant malignomas, psychiatric and neurological complications) five or more years after transplantation including educational status, occupation and living situation. Secondary outcome contained association of pre-transplant patient specific parameters to post transplant outcome. <h3>Results</h3> Out of the 73 pediatric patients, who underwent lung transplantation between 1993 and 2013 at Medical University Vienna, 30 patients survived at least 5 years after transplantation. Median survival of these patients was 192.3 months, 10-year and 15-years survival 85% and 54%, respectively. Mean FEV1%pred 5 years after transplantation was 61%, after 10 years 54%. A statistically significant increase of the median BMI percentile rank from time of transplantation to five years post transplantation was observed. From 1993 to 2002 the 10-year survival rate was 63%, whereas from 2003 to 2013 it was 100%, underlining the improvement in pediatric lung transplantation. No significant differences could be detected analyzing the influence of specific parameters (e.g. gender, underlying disease, age) on survival. <h3>Conclusion</h3> We did not only observe a remarkably high long term survival rate, but also very satisfying results regarding health state in pediatric lung transplant recipients surviving at least five years after transplantation. Complications are considerable, however most importantly the majority of complications is temporary and/or are manageable.