Ms. Woo et al., Bronchiolitis obliterans is not the primary cause of death in pediatric living donor lobar lung transplant recipients, J HEART LUN, 20(5), 2001, pp. 491-496
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.