Minimal acute rejection in pediatric lung transplantation--does it matter?
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.
Benden
Christian
C
Division of Pulmonary Medicine, University Hospital, Zurich, Switzerland. christian_benden@yahoo.de
Faro
Albert
A
Worley
Sarah
S
Arrigain
Susana
S
Aurora
Paul
P
Ballmann
Manfred
M
Boyer
Debra
D
Conrad
Carol
C
Eichler
Irmgard
I
Elidemir
Okan
O
Goldfarb
Samuel
S
Mallory
George B
GB
Mogayzel
Peter J
PJ
Parakininkas
Daiva
D
Solomon
Melinda
M
Visner
Gary
G
Sweet
Stuart C
SC
Danziger-Isakov
Lara A
LA
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