title: Minimal acute rejection in pediatric lung transplantation--does it matter?
abstract: In adult lung transplantation, a single minimal AR episode is a significant predictor of BOS independent of other factors. However, the significance of single minimal AR episodes in children is unknown. A retrospective, multi-center analysis was performed to determine whether isolated single AR episodes are associated with an increased BOS risk in children. Risk factors for BOS, death, or re-transplantation, and a combined outcome of BOS, death, or re-transplantation were assessed. Original data included 577 patients (<21 yr of age). A total of 383 subjects were eligible for the study. Fifteen percent of patients developed BOS, and 13% of patients either died or underwent re-transplant within one-yr post-transplant. In the multivariable survival model for time to BOS, there was no significant risk to developing BOS after a single minimal AR (A1) episode (HR 1.7, 95% CI 0.64-4.8; p=0.28). Even after a second minimal AR episode, no significant risk for BOS was appreciated. However, a single episode of mild AR (A2) was associated with twice the risk of BOS within one-yr post-transplant. In this select cohort, a single minimal AR episode was not associated with an increased risk for BOS within one yr following lung transplantation, in contrast to previous reports in adults.
authors.affiliation: Division of Pulmonary Medicine, University Hospital, Zurich, Switzerland. christian_benden@yahoo.de
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.forename: Albert
authors.initials: A
authors.lastname: Faro
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.forename: Paul
authors.initials: P
authors.lastname: Aurora
authors.forename: Manfred
authors.initials: M
authors.lastname: Ballmann
authors.forename: Debra
authors.initials: D
authors.lastname: Boyer
authors.forename: Carol
authors.initials: C
authors.lastname: Conrad
authors.forename: Irmgard
authors.initials: I
authors.lastname: Eichler
authors.forename: Okan
authors.initials: O
authors.lastname: Elidemir
authors.forename: Samuel
authors.initials: S
authors.lastname: Goldfarb
authors.forename: George B
authors.initials: GB
authors.lastname: Mallory
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mogayzel
authors.forename: Daiva
authors.initials: D
authors.lastname: Parakininkas
authors.forename: Melinda
authors.initials: M
authors.lastname: Solomon
authors.forename: Gary
authors.initials: G
authors.lastname: Visner
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Sweet
authors.forename: Lara A
authors.initials: LA
authors.lastname: Danziger-Isakov
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001989:Bronchiolitis Obliterans / Q000401:mortality / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007223:Infant; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis