TY - JOUR
T1 - Lung transplantation in infants and toddlers from 1990 to 2004 at St. Louis children's hospital
AU - Elizur, A.
AU - Faro, A.
AU - Huddleston, C. B.
AU - Gandhi, S. K.
AU - White, D.
AU - Kuklinski, C. A.
AU - Sweet, S. C.
PY - 2009/4
Y1 - 2009/4
N2 - 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.
AB - 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.
KW - Acute rejection
KW - Bronchiolitis obliterans
KW - Graft survival
KW - Growth after transplant
KW - Infants
KW - Lung transplantation
UR - http://www.scopus.com/inward/record.url?scp=63349093650&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2009.02552.x
DO - 10.1111/j.1600-6143.2009.02552.x
M3 - Article
C2 - 19344463
AN - SCOPUS:63349093650
SN - 1600-6135
VL - 9
SP - 719
EP - 726
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 4
ER -