Outcome and obstacles in pediatric lung and heart-lung transplantation

Pediatric lung or heart-lung transplantation (pL/HLTx) represents a challenge for an extraordinary patient population. The requirements in immunosuppressive therapy and the associated risks result in disappointing long term results, especially when the life expectancy of this age group is taken into account. Also, due to the size of these patients, the donor pool for the individual recipient is significantly smaller, compared to that of adult patients. We performed a retrospective analysis of our patient cohort and compared the results of pediatric to adult patients. Methods: Out of a total of more than 660 L/HLTx recipients at our institution, 65 patients (pts.) belong to the pediatric group ( 20 years), with 46 pts. between 16 and 20 years of age, 15 pts. between 11 and 15, 2 between 5 and 10, and 2 between 0 and 5. 13 underwent transplantation in 2003, 7 up to Sept. in 2004. Due to the severe organ shortage, we have begun to routinely transplant reduced size (RS) organs in the pediatric LTx group since 2003. Main underlying disease was CF (45%). 1 year survival was 66 7% vs. 77 2% in the adult group, 3 year survival was 56 8 %, compared to 69 2% survival in adults. Comparison of survival of RS size to non-RS size LTx shows no difference in outcome. As with all pediatric pts. undergoing solid organ transplants, we noted a significantly increased rate of rejections. Our data corroborate that pL/HLTx is associated with a differing scope of complications and therapeutic requirements. Since survival does not differ between RS LTx and non-RS LTx, RS LTx offers means to enlarge the donor pool for pediatric recipients. Due to the specific requirements pL/HLTx should be performed by specialized programs, and adapted treatment and monitoring regimes have to be developed, to increase the long term results following pL/HLTx.