Two decades of pediatric lung transplant in the United States: have we improved?
OBJECTIVE
Since 1988, approximately 1100 pediatric lung transplants have been performed worldwide with consistent improvement in survival. Similarly, survival for pediatric heart transplant has increased over the years; however, in this cohort improvement in survival is exclusively a result of increased early (1-year) survival. To observe if this same phenomenon exists in pediatric lung transplants, the United Network for Organ Sharing database was analyzed to evaluate and characterize how pediatric lung transplant survival has changed in the past 2 decades.


METHODS
The United Network for Organ Sharing database was queried for patients aged 18 years or less who underwent lung transplantation from May 1988 to May 2008. Analysis included 959 pediatric lung transplants.


RESULTS
Age groups were infants (≤1 years) (n = 106 [11%]), children (2-12 years) (n = 299 [31%]), and adolescents (≥13 years) (n = 554 [58%]). A total of 546 (57%) were girls. Kaplan-Meier survival was significantly better in the late era (2002-2008) than in all other eras (1988-1994 and 1995-2001) (P < .05). The half-life for graft has increased significantly over the eras (early, 2.2 years; mid, 3.3 years; and late, 3.8 years). Conditional 1-year survival (ie, mid to late survival) was not significantly different (P = .3) among the eras. Gender, age, diagnosis, prolonged ischemic time, and cytomegalovirus mismatch did not significantly affect overall patient or graft survival. Chronic preoperative steroid dependence (P = .02), preoperative ventilatory dependence (P < .001), and retransplantation (P = .02) were associated with decreased survival.


CONCLUSIONS
Survival in pediatric lung transplant has increased significantly over the years, but this improvement primarily reflects improvement in early survival. Survival in pediatric lung transplant after the first posttransplant year has not changed in more than 2 decades.
Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, Tex 77030, USA. fxzafar@texaschildrenshospital.org
Farhan
F
Zafar
Jeffrey S
JS
Heinle
Marc G
MG
Schecter
Joseph W
JW
Rossano
George B
GB
Mallory
Okan
O
Elidemir
David L S
DL
Morales
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000266:history / Q000401:mortality* / Q000639:trends; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology