Outcomes of adolescent recipients after lung transplantation: An analysis of the International Society for Heart and Lung Transplantation Registry.
Recipient adolescent age for non-lung solid-organ transplantation is associated with higher rates of rejection, graft loss and mortality. Although there have been no studies specifically examining adolescent outcomes after lung transplantation (LTx), limited data from the International Society of Heart and Lung Transplantation (ISHLT) Registry suggest that a similar association may exist. Recently, adolescence has been defined as 10 to 24 years of age, taking into account the biologic and sociologic transitions that occur during this age interval.



The ISHLT Registry was used to examine the survival outcomes of LTx recipients 10 to 24 years of age between 2005 and 2013. Given the developmental changes that occur in adolescence, survival outcomes for the tertiles of adolescence (10 to 14, 15 to 19 and 20 to 24 years old) were also examined.



Adolescents made up 9% (n = 2,319) of the 24,730 LTxs undertaken during the study period. Kaplan-Meier survival estimates at 3 years showed lower adolescent survival (65%) when compared with younger children (73%, p = 0.006) and adults 25 to 34 (75%, p < 0.00001) and 35 to 49 (71%, p < 0.00001) years of age, without a significant survival difference compared with those 50 to 65 years old. Critically, 15- to 19-year-old recipients had the poorest outcomes, with reduced 1-year survival (82%) compared with those 10 to 14 years old (88%, p = 0.02), and reduced 3-year survival (59%) compared with those 10 to 14 (73%, p < 0.00001) and 20 to 24 (66%, p < 0.0001) years old.



Adolescent LTx recipients have poorer overall survival when compared with younger children and adults, with those 15 to 19 years old having the highest risk of death. This survival disparity among age groups likely reflects the difficult period of adolescence and its biologic and social transitions, which may influence both immunologic function and adherence.
Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: m.paraskeva@alfred.org.au.
Miranda A
MA
Paraskeva
The International Society for Heart and Lung Transplantation Transplant Registry, Dallas, Texas, USA; United Network for Organ Sharing, Richmond, Virginia, USA.
Leah B
LB
Edwards
Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia; The International Society for Heart and Lung Transplantation Transplant Registry, Dallas, Texas, USA.
Bronwyn
B
Levvey
The International Society for Heart and Lung Transplantation Transplant Registry, Dallas, Texas, USA; United Network for Organ Sharing, Richmond, Virginia, USA.
Josef
J
Stehlik
The International Society for Heart and Lung Transplantation Transplant Registry, Dallas, Texas, USA; Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Samuel
S
Goldfarb
The International Society for Heart and Lung Transplantation Transplant Registry, Dallas, Texas, USA; Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Roger D
RD
Yusen
Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia.
Glen P
GP
Westall
Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia.
Greg I
GI
Snell
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007391:International Cooperation; D016040:Lung Transplantation; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012955:Societies, Medical; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
adolescent; adult; pediatric; survival; transplantation