PEDIATRIC LUNG TRANSPLANTATION AT ST-LOUIS CHILDRENS-HOSPITAL, 1990-1995

Although accepted therapy in adults, lung transplantation in children is less well established. Reports from the few existing pediatric cent ers have involved relatively small patient number. Seventy-nine patien ts underwent 88 lung transplant procedures at St. Louis Children's Hos pital between June 1990 and August 1995. Twenty-one transplants (24%) were done in 19 infants and children under the age of 3 yr. Twelve-, 2 4-, and 48-mo actuarial survival for the primary transplants was 69%, 67%, and 60%, respectively. Survival improved over the course of the p rogram: 12-mo survival for patients transplanted during the first 18 m o was 42% compared with 78% for those transplanted after December 1991 . Survival of children transplanted at younger than 3 yr of age was co mparable to older children and adults. However, younger children had a lower incidence of acute rejection; none developed bronchiolitis obli terans. Both graft growth and linear growth occurred. Risk factors for early mortality included presence of aortopulmonary collateral vessel s and prior thoracic surgery. Risk factors for survival duration inclu ded requiring assisted ventilation at the time of transplant, continuo us supplemental oxygen requirement, and presence of aortopulmonary col lateral vessels. The major late complication was bronchiolitis obliter ans, which occurred in 27% of patients and played a role in 64% of lat e deaths. Investigation of the lower incidence of acute rejection and bronchiolitis obliterans in younger versus older children may reveal i mportant information about the etiology of this disease. The ultimate long-term success of lung transplantation will depend on identificatio n and treatment of the mechanisms responsible. A multicenter data regi stry would facilitate further clinical studies of pediatric lung trans plantation.