Bronchiolitis obliterans is not the primary cause of death in pediatric living donor lobar lung transplant recipients

Background: Obliterative bronchiolitis (OB) is the chief cause of mortality in cadaveric lung transplant patients (CL). But, is OB the primary cause o f mortality for living donor lobar recipients? To answer this question, we reviewed the causes of mortality in our pediatric patients who underwent li ving donor lobar lung transplantation (LD) and compared them with our pedia tric patients who received whole cadaveric lungs (CL). Methods: Data collected included demographics, transplant type, hospital da ys, Immunosuppression regimen, and cause of death. Statistical analysis was done using Fisher's Exact test and Student's t-test (mean +/- SD). Results: From May 1993 to December 1999, 53 patients underwent lung transpl antation (21 males, 32 females; mean age 12.4 +/- 5.4 years). Twenty-nine p atients had LD procedures (12 males, 17 females; mean age 14.4 +/- 3.6 year s) and 24 patients had CL surgery (9 males, 15 females; p=.78 [not signific ant]; mean age 9.8 +/- 6.3 years; p =.001). All patients received triple im munosuppression without induction. During the study period, 9 LD (6 males, 3 females; mean age 15.7 +/- 5.0 years) and 14 CL (3 males, 11 females; mea n age 11.3 +/- 6.9 years) patients died. There was no significant differenc e between patients hi the LD and CL groups who died with regard to gender ( p =.08), age at the time of death (p =.12), mortality rate (p =.06), number of hospital days (p =.09), immunosuppressive medications (p >.08), inciden ce of non-specific graft failure (p =.26), or incidence of infection (p =.1 8). However, there was a significant difference in the incidence of OB betw een LD and CL recipients (p =.002). Conclusions: OB was not found to be the chief cause of mortality in pediatr ic LD recipients. We speculate that prevention of infections, possibly by a modest reduction in immunosuppressive therapy and aggressive antimicrobial therapy, may improve longterm survival in pediatric living donor lobar lun g transplant recipients.