title: Lung transplantation in childhood and adolescence: unicentric 14-year experience with sex matching as the main prognosticator.
abstract: OBJECTIVE
  Lung transplantation (LTx) is an accepted therapy for selected infants, children and adolescents with end-stage lung and pulmonary vascular disease. It remains a challenge for a selected group of patients. In 2011, the number of paediatric lung transplantations (PLTxs) worldwide was 107. In France, a total of 131 PLTxs have been performed since 2000 (data from ABM: Agence de biomédecine), 65 of which were conducted at our institution.
  
  
  METHODS
  All patients under 18 (4.8-17.11) years of age matching inclusion and exclusion criteria, who underwent LTx at our institution were included in this study (n = 58). We analysed the outcomes of these patients in terms of survival rates, controlling for indications for transplantations and surgical procedures. Secondary outcomes were analysis of surgical and medical complications and identification of prognostic factors in the field of LTx in these categories of ages.
  
  
  RESULTS
  The 30-day mortality rate was 10%. Kaplan-Meier survival rates at 1 month, 1, 3, 5 and 10 years were 90, 81, 66, 60 and 57%, respectively; the median survival was 91 months. Reduced-size transplantation was performed in 33% of double-lung transplantation (DLTx) patients without negatively impacting survival. In our series, female sex, the presence of a sex mismatching and, in particular, the occurrence of a male donor to a female recipient (F/M group) have been poor prognostic factors after PLTx.
  
  
  CONCLUSIONS
  The overall survival after PLTx was encouraging (57% at 10 years). A PLTx should be offered to the small number of patients with end-stage pulmonary disease. The limited number of paediatric donor organs can be overcome by using reduced-size organs without a survival disadvantage to the patients. In our series, male sex and sex matching seemed to be positive predictive prognostic factors after PLTx but further studies are required to confirm these results and to also clarify the role of age of donor, time of cold ischaemia and body mass index in PLTx.
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France g.mangiameli@unicampus.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mangiameli
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France.
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.affiliation: Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Boussaud
authors.affiliation: Deparment of Public Health, Hygiene and Statistics Research Unit, Campus Bio-Medico University, Rome, Italy.
authors.forename: Tommasangelo
authors.initials: T
authors.lastname: Petitti
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rivera
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France.
authors.forename: Ciprian
authors.initials: C
authors.lastname: Pricopi
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Badia
authors.affiliation: Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Achouh
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Legras
authors.affiliation: Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guillemain
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.affiliation: Department of Anesthesia and Resuscitation HEGP, Georges Pompidou European Hospital, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Cholley
authors.affiliation: General Pediatric Department, CRCM, Necker Enfants Malades Hospital, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sermet
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Georges Pompidou European Hospital, Paris, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D066027:Transplant Recipients / Q000706:statistics & numerical data*
keywords: Childhood and adolescence; Female recipient; Lung transplantation; Male donor; Sex matching