Comparison of outcomes between living donor and cadaveric lung transplantation in children

doi:10.1016/S0003-4975(99)01155-8

The Annals of Thoracic Surgery

Volume 68, Issue 6, December 1999, Pages 2279-2283

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

https://doi.org/10.1016/S0003-4975(99)01155-8 Get rights and content

Abstract

Background. Long-term survival in lung transplant is limited by bronchiolitis obliterans (BOS). We compared outcomes in pediatric living donor bilateral lobar (LL) vs cadaveric lung transplant (CL).

Methods. Children were studied who had LL or CL with at least 1 year follow-up. Data collected included acute rejection episodes, pulmonary function tests (PFT), BOS, and survival. Mean age was 13.36 ± 3.16 years in LL and 12.00 ± 4.19 years in CL patients (p = 0.37, ns).

Results. There was no difference in rejection (p = 0.41, ns). CL had rejection earlier (2.48 ± 3.84 months) than LL (13.60 ± 10.74 months; p = 0.02). There was no difference in 12 month PFT. But at 24 months, LL had greater forced expiratory volume in 1 second (FEV₁) (p = 0.001) and FEF_25–75% (p = 0.01) than CL. BOS was found in 0/14 LL vs 9/11 (82%) CL after 1 year (p = 0.04). After 2 years, 0/8 LL and 6/7 (86%) CL had BOS (p < 0.05). LL had 85% survival vs 79% for CL at 12 months. At 24 months, LL survival was 77% vs 67% for CL.

Conclusions. Pediatric LL had less BOS and better pulmonary function than CL. As BOS is a determinant of long-term outcome, we believe LL is the preferred lung transplant method for children.

Section snippets

Material and methods

The study population consisted of pediatric patients who received living donor bilateral lobar (LL) transplantation at Childrens Hospital Los Angeles from 1993 through 1998. All children who underwent LL surgery were also listed for cadaveric organs. However, their disease severity and progression led us and their referring physicians to believe that they would not survive to receive cadaveric lung transplantation. Inclusion criteria included no documentation of medication noncompliance,

Results

A total of 28 children who could perform pulmonary function tests received lung transplants during the study period. Three of these patients had documented repeated episodes of medication noncompliance and were excluded from analysis. Fourteen patients (6 males:8 females; mean age 13.36 ± 3.16 years) who underwent LL procedure met the inclusion criteria at 1 year posttransplantation. Ten had cystic fibrosis and 4 had primary pulmonary hypertension. Eleven patients (5 males:6 females; mean age

Comment

The introduction of living donor lobar lung transplantation was in response to cadaveric lung donor shortage. The shortage of suitable donors is particularly prevalent in children, where 20% to 30% of the waiting recipients die while waiting on transplant lists. Living donor lobar lung transplantation was initially performed in children with limited life expectancy (less than 2 weeks). As experience with this type of lung transplant was gained, comparisons to cadaveric lung transplant

Acknowledgements

The authors gratefully acknowledge the assistance of Rosemary Allen in the preparation of this manuscript.

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Original ArticlesComparison of outcomes between living donor and cadaveric lung transplantation in children

Abstract

Section snippets

Material and methods

Results

Comment

Acknowledgements

J Thorac Cardiovasc Surg

Clin Chest Med

J Thorac Cardiovasc Surg

Clin Chest Med

Clin Chest Med

Chest

Living donor lobar lung transplantationthe pediatric experience

Pediatr Transplant

A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation

J Heart Lung Transplant

Does histologic acute rejection in lung allografts predict the development of bronchiolitis obliterans?

Transplantation

Original Articles
Comparison of outcomes between living donor and cadaveric lung transplantation in children