Heart-lung and lung transplantation have become acceptable therapeutic
modalities for end-stage lung and heart conditions in children and yo
ung adults, but the posttransplantation pulmonary pathology in this ag
e-group is poorly characterized, We present our experience with the pa
thology of lung transplantation in a cohort of 11 patients with a medi
an age of 12.5 years, and median posttransplantation follow-up of 8.3
months. The findings are based on histological examination of 98 speci
mens, including five autopsy specimens from patients 20 years of age o
r younger. Our experience, combined with the data in other pediatric s
eries, suggest that there is not a significant difference in the preva
lence or severity of acute rejection or bronchiolitis obliterans (BO)
between adult and pediatric lung transplant recipients. Lymphocytic br
onchitis/bronchiolitis showed a more prominent association with BO in
our series than previously reported in adult studies. Chronic vascular
rejection in the pediatric lung transplant recipients can occur earli
er than reported in adults and is associated with a grave prognosis, O
verwhelming infection was a major cause of death in our experience. In
particular, our data combined with the previous reports indicate that
adenoviral pneumonia is a relatively common pathogen in the pediatric
population and is a major cause of mortality in this age-group. Copyr
ight (C) 1997 by W.B. Saunders Company.