Chronic respiratory complications in pediatric heart transplant recipients.
BACKGROUND
The frequency and spectrum of chronic respiratory complications in pediatric heart transplant recipients have not been extensively studied. The aim of this study was to describe the chronic respiratory complications in 126 consecutive pediatric heart transplant recipients.


METHODS
Retrospective review of medical records.


RESULTS
Between 1987 and 2005, 126 (64 males and 62 females) heart transplantations were performed at Freeman Hospital, Newcastle upon Tyne, United Kingdom. The median age at transplantation was 7.4 years (range, 0.1-17) and the median length of follow-up was 6.8 years (range, 0-18.2). Twenty-four patients have died, and 36 have been transferred to adult follow-up, leaving 66 under pediatric follow-up. Chronic respiratory complications have been documented in 33 children (50%). Bronchiectasis has been identified in 10 children, and 12 further children have had recurrent lower respiratory tract infections (without bronchiectasis) requiring long-term antibiotic prophylaxis. Of those with infectious complications, 81% underwent transplantation before 4 years and had deficiency of pneumococcal-specific antibody response. Obstructive sleep apnea has occurred in 5 children, sub-glottic stenosis has occurred in 3, and significant compression of the left main stem bronchus related to a disproportionately large donor heart has occurred in 2. One child had marked mosaic attenuation on chest computed tomography scan indicative of small airways disease.


CONCLUSIONS
Chronic respiratory complications are common in pediatric heart transplant recipients. The respiratory prognosis for this complex group of patients is usually good, but long-term follow-up by both a respiratory pediatrician and an immunologist is frequently required.
Thomas
Biju
B
Regional Cardiothoracic Centre, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Flet
Julie G
JG
Shyam
Rajendran
R
Kirk
Richard C
RC
Gennery
Andrew R
AR
Spencer
David A
DA
D000293:Adolescent; D001982:Bronchial Diseases / Q000209:etiology; D001987:Bronchiectasis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000209:etiology; D008297:Male; D012120:Respiration Disorders / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology