title: Lung transplantation for childhood diffuse lung disease.
abstract: BACKGROUND
  Pediatric diffuse lung diseases comprise a heterogeneous group of rare lung disorders which may lead to end stage lung disease and referral for lung transplantation. Previous studies are limited by small numbers of patients with specific forms of diffuse lung disease. Children with all forms of diffuse lung disease who underwent lung transplantation at two pediatric centers were evaluated in terms of several pre- and post-transplant factors and compared to children with other end stage lung disorders.
  
  
  METHODS
  A retrospective chart review was performed on all patients transplanted between October 1, 2002 and June 15, 2007 at Texas Children's Hospital and St. Louis Children's Hospital. Multiple pre-transplant characteristics and post-transplant morbidities and mortality were compared between diffuse lung disease, cystic fibrosis, and pulmonary vascular disease groups.
  
  
  RESULTS
  There were 31 diffuse lung disease (DLD), 57 cystic fibrosis (CF), and 16 pulmonary vascular disease (PVD) patients included in our analysis. Patients with DLD had significantly higher pre-transplant morbidity including lower percent predicted of forced expiratory volume in first second (P = 0.013) and more patients with pulmonary hypertension (P = 0.001) and hypercapnia (P = 0.031). Compared to CF patients, more DLD and PVD patients required invasive ventilation (P = 0.001) and care in the pediatric intensive care unit (P = 0.001). After transplant, there was a difference among the three groups with regards to number of acute allograft rejections but statistical limitations preclude knowing between which group the difference lies. A difference in time to bronchiolitis obliterans was found between the PVD and CF groups but not when compared to the DLD patients. The three groups had similar time to post-transplant lymphoproliferative disease, rate of infections, and survival.
  
  
  CONCLUSIONS
  Lung transplantation is as successful for patients with end stage diffuse lung disease as compared to other lung transplant candidates.
authors.affiliation: Pediatric Pulmonary Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA. jarama@texaschildrens.org
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Rama
authors.forename: Leland L
authors.initials: LL
authors.lastname: Fan
authors.forename: Albert
authors.initials: A
authors.lastname: Faro
authors.forename: Okan
authors.initials: O
authors.lastname: Elidemir
authors.forename: David L
authors.initials: DL
authors.lastname: Morales
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heinle
authors.forename: E O'Brian
authors.initials: EO
authors.lastname: Smith
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Hazen
authors.forename: Siby P
authors.initials: SP
authors.lastname: Moonnumakal
authors.forename: George B
authors.initials: GB
authors.lastname: Mallory
authors.forename: Marc G
authors.initials: MG
authors.lastname: Schecter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017563:Lung Diseases, Interstitial / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation; D008232:Lymphoproliferative Disorders / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies