A Multicentric Evaluation of Pediatric Lung Transplantation in Italy

Purpose Pediatric lung transplantation is performed only in high-experienced centers due to the peculiarity of these patients.This has often discussed only by limited case-series; moreover in the international register the data do not frequently report peculiarities of single countries.The purpose of this study was to analyze the results of pediatric lung transplantation in Italy. Methods The multicentric retrospective analysis was carried out on 110 pediatric patients ( Results The population was composed of 44 males and 66 females with a median age of 15 years. The most frequent indication was cystic fibrosis (83%) with a median waiting list time of 235 days.Pre-operatively, 42% of patients were transplanted in emergency setting, assisted by ECMO and/or mechanically ventilation. Median donor Oto Score was 1 while median donor age 15 years with 43% adults (age>= 18 years).A predominance of bilateral transplantation was recorded (98%); in 17% of patients a graft reduction for size mismatch was performed, with lobectomy in 78% of them. Post-operatively, PGD 3 at 72 h was found in 15% of patients while median time for mechanical ventilation, ICU and intra-hospital stay were 48 hours, 11 days and 35 days, respectively. Anastomotic complications were observed in 6.5% of patients.Thirty-days mortality was 6% and 1,5 and 10-years survival 72%, 52% and 33% respectively with a best FEV1 of 84%. 34% of patients experienced chronic rejection with a 5-year CLAD-free survival of 77%; 12.7% of subjects required retransplantation mainly due to CLAD (71%).The univariate analysis for mortality risk factors revealed a direct correlation with Oto Score and BMI. No other influences were observed in particular for graft reduction and donor age. Conclusion This multicentric analysis shows that pediatric lung transplantation in Italy presents results comparable with data reported in the current literature.Particular care should be considered with BMI recipient and donor Oto score. Conversely, adult donors and volumetric graft reductions can be safely used in order to expand the pool of donors, reducing waiting list time and mortality.