20. A Comparison of Outcomes Between Living Lobar and Cadaveric Lung Transplantation in Children

Vaughn A. Starnes, Eithne A. MacLaughlin*, Marlyn W. Woo*, Monica V. Horn*, Pierre C. Wong*, Jon Rowland*, Winfield J. Wells, and Mark L. Barr*, Los Angeles, CA

Long-term survival in lung transplantation is limited by bronchiolitis obliterans syndrome in both adults and children. In our institution, we have had the unique opportunity of comparing outcomes in living donor bilateral lobar lung versus cadaveric whole lung transplantation in children.

Methods: All pediatric patients who underwent lobar lung or whole lung transplantation at Childrens Hospital Los Angeles with follow-up at least of one year and who performed pulmonary function tests were included in this study. Data collected included demographic information, FEV₁, FEF_25-75%, vital capacity, SaO₂, exercise stress tests, bronchiolitis obliterans syndrome, quality of life, and survival/mortality. Mean age was 13± 3 years in lobar lung and 12± 4 years in whole lung patients. Results were compared between groups using Student's t-test, Fisher's Exact, and Kaplan-Meier Survival analysis. Significance was at p<0.05.

Spirometry results were:

Patient (n)	FEV1(% pred)	FEF26-75%(%pred)	VC (%pred)	Sa02(%)
LL 12 mo (10)	70.0± 22	58.8± 22.8	81.0± 19.0	97.8± 1.8
CL 12 mo (11)	64.5± 2.0	45.4± 22.2	79.5± 21.0	97.9± 1.2
p-value 12 mo	0.56	0.18	0.81	0.87
LL 24 mo (6)	76.3± 16.4	62.3± 16.4	87.3± 21.4	98.0± 0.6
CL 24 mo (7)	43.0± 24.4	35.6± 26.7	60.0± 27.6	94.4± 4.5
p-value 24 mo	.01	.06	.08	.08

 

There was no difference in the 12-month exercise stress tests results between lobar lung and whole lung recipients. Lobar lung recipients had normal hemodynamic studies by cardiac catheterization. Clinical bronchiolitis obliterans syndrome was present in no lobar lung patients and 6/11 whole lung patients (54.6%) by two years post-transplant (p<0.04). All lobar lung patients and 8/11 whole lung patients (78%) returned to full-time school. The lobar lung had 84% survival at 12 months compared to 78% for whole lung patients.

Conclusions: Based upon these data, lobar lung recipients developed significantly less (P<0.04) and had better pulmonary spirometry than did the cadaveric lung group. The successful long-term outcome of lung transplantation is dependent upon the absence of bronchiolitis obliterans syndrome, therefore we believe this report favors living lobar lung transplantation as the preferred method of lung transplant for children.