Pneumologie 2005; 59 - P283
DOI: 10.1055/s-2005-864497

Long-term outcome in pediatric lung and heart-lung transplantation

M Dandel 1, C Knosalla 1, O Grauhan 1, C Witt 2, R Hetzer 1, Y Weng 1, S Mulahasanovic 1, H Lehmkuhl 1, G Guenther 1
  • 1Deutsches Herzzentrum Berlin
  • 2Abteilung für Pneumologie, Charité Campus Mitte, Berlin

Outcome information after pediatric lung (LTx) and heart-lung transplantations (HLTx) is available mainly from cumulative ISHLT-registry data. We looked for mortality risk factors after pediatric LTx/HLTx with special attention focused on regional-/center-specific features.

Methods: We evaluated our pediatric lung/heart-lung recipients transplanted between 8/1992–8/2001. Attention was paid to recipient age and gender, donor-recipient interactions, indication for Tx, rejection treatments and post-Tx morbidities.

Results: Up until 8/2001, 21 pediatric patients (11 girls), underwent LTx (n=10) or HLTx (n=11). At evaluation time (8/2004) the longest survival was12 years. Survival rates were 62% at 3 years and 53% at 5 years. In those who survived the first post-Tx year median survival reached 6,1 years. Survival was better in girls and better after HLTx than after LTx (p<0,01). Bronchiolitis obliterans (BO) was diagnosed in all who died beyond the 6th post-Tx month and was the main cause of death in 85,7% of these patients. All BO patients had recurrent rejections, 44,4% were cytomegalovirus (CMV) mismatched and 89% had CMV infections. Among the >5-year survivors, 71,4% were CMV donor-negative and recipient-negative (D-/R-). None of the D-/R-patients died after the 6th post-Tx month (survival at present: 7,9±2,2 years) and none has BO, although their post-Tx times were 5–12 years.

Conclusions: In children the post-Tx survival was better in females and also better after HLTx than after LTx. After the first post-Tx year, BO was the main cause of death. CMV was the major cause of BO. Best long-term outcome was shown by CMV D-/R-patients.