Pediatric Lung Transplantation−Intermediate Outcomes of a Japanese Center

Abstract

<h3>Purpose</h3> Since 1998 our center has performed not only cadaveric lung transplantation (CLTx) but living-donor lobar lung LTx (LDLLTx), especially recently, including non-standard procedures of middle lobe LTx and segmental LTx in order to save younger children. The aim of this study was to show outcomes of pediatric LTx of a lung transplant center in Japan. <h3>Methods</h3> We retrospectively reviewed 203 consecutive LTx recipients between 1998 and 2020 including 43 pediatric (< 18 years old: CLTx [n = 9], LDLLTx [n = 34]) and 160 adult (≥18 years old: CLTx [n = 99], LDLLTx [n = 60]) recipients. We analyzed pediatric recipients in subgroups divided at the school age (0-6 years old [n = 10] vs 7-17 years old [n = 33]). <h3>Results</h3> The 1-, 5-, and 10-year overall survival (OS) in pediatric vs adult recipients were 93% vs 91%, 84% vs 74% and, 79% vs 61%, respectively (p = 0.11). The 1-, 5-, and 10-year lung-graft survival (GS) in pediatric vs adult recipients were 85% vs 83%,62% vs 62% and 36% vs 48%, respectively (p = 0.26). There was no significant difference in survival rates between pediatric and adult recipients. In pediatric recipients, the 1- and 5-year OS in 0-6 years old vs 7-17 years old were 70% vs 100% and 56% vs 92%, respectively (p = 0.004). The 1- and 5-year GS in 0-6 years old vs 7-17 years old were 60% vs 93% and 24% vs 72%, respectively (p = 0.02). Although the number is small, younger children under 7 years old have poorer OS and GS when compared with older children of 7-17 years old. From patient characteristics, lower height (p < 0.0001), non-standard LTx procedure (p = 0.001),idiopathic interstitial pneumonia (p = 0.004) and on-ventilation at LTx (p = 0.007) might be factors associated with poor outcome. <h3>Conclusion</h3> Outcome of pediatric LTx is comparable with that of adult LTx. However, younger children under 7 years old have poorer OS and GS compared with older children of 7-17 years old.