A multicentric evaluation of pediatric lung transplantation in Italy,The Journal of Thoracic and Cardiovascular Surgery

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A multicentric evaluation of pediatric lung transplantation in Italy
The Journal of Thoracic and Cardiovascular Surgery ( IF 4.9 ) Pub Date : 2022-06-20 , DOI: 10.1016/j.jtcvs.2022.06.010
Marco Schiavon ₁ , Stefania Camagni ₂ , Federico Venuta ₃ , Lorenzo Rosso ₄ , Massimo Boffini ₅ , Francesco Parisi ₆ , Alessandro Bertani ₇ , Federica Meloni ₈ , Piero Paladini ₉ , Eleonora Faccioli ₁ , Michele Colledan ₂ , Daniele Diso ₃ , Margherita Cattaneo ₄ , Fabrizio Scalini ₅ , Sara Alfieri ₆ , Domenica Giunta ₇ , Monica Morosini ₈ , Luca Luzzi ₉ , Giulia Lorenzoni ₁₀ , Andrea Dell'Amore ₁ , Federico Rea ₁

Affiliation

Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy.
Department of Organ Failure and Transplantation, ASST Giovanni XXIII, Bergamo, Italy.
Department of Organ Failure and Transplantation, University of Rome, Rome, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy.
Surgical Sciences, University of Torino, Torino, Italy.
Thoracic Transplant and Pulmonary Hypertension Unit, Bambino Gesù Children Hospital, Rome, Italy.
Division of Thoracic Surgery and Lung Transplantation, IRCCS ISMETT-UPMC, Palermo, Italy.
Respiratory Disease Department, IRCCS San Matteo Foundation and University Pavia, Pavia, Italy.
University of Siena, Siena, Italy, Azienda Ospedaliera Le Scotte, Siena, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua, Padova, Italy.

Background

Pediatric lung transplantation is performed in highly experienced centers due to the peculiar population characteristics. The literature is limited and not representative of individual countries' differences. The purpose of this study was to analyze the Italian experience.

Methods

A multicentric retrospective analysis was performed on 110 pediatric patients (<18 years old) who underwent lung transplantation from 1992 to 2019 at 9 Italian centers. Heart–lung transplantations and lung retransplantations were excluded.

Results

The population was composed of 44 male and 66 female patients, with a median age of 15 years. The most frequent indication was cystic fibrosis (83%). One quarter of patients were transplanted in an emergency setting. Median donors' Oto score and age were 1 and 15 years, respectively, with 43% of adult donors. In 17% of patients a graft reduction was performed. Postoperatively, the median duration of mechanical ventilation, intensive care unit, and in-hospital stay were 48 hours, 11 and 35 days, respectively. Thirty-day mortality was 6%, and 1-, 5-, and 10-year survival was 72%, 52%, and 33%, respectively. Risk factors for mortality were Oto score and recipients' body mass index.

Conclusions

The outcomes of pediatric lung transplantation in Italy are comparable with current literature. Particular attention should be paid to the Oto score and recipient body mass index. Conversely, adult donors and graft reductions can be safely used to expand the donor pool.

中文翻译：

意大利小儿肺移植的多中心评估

背景

由于特殊的人群特征，小儿肺移植在经验丰富的中心进行。文献有限，不能代表各个国家的差异。本研究的目的是分析意大利的经验。

方法

对 1992 年至 2019 年在意大利 9 个中心接受肺移植的 110 名儿科患者（<18 岁）进行了多中心回顾性分析。心肺移植和肺再移植被排除在外。

结果

该人群由 44 名男性患者和 66 名女性患者组成，中位年龄为 15 岁。最常见的适应症是囊性纤维化(83%)。四分之一的患者是在紧急情况下移植的。捐赠者的 Oto 评分中位数和年龄分别为 1 岁和 15 岁，其中 43% 为成人捐赠者。17% 的患者进行了移植物复位。术后，机械通气、重症监护室和住院时间的中位数分别为 48 小时、11 天和 35 天。30 天死亡率为 6%，1 年、5 年和 10 年生存率分别为 72%、52% 和 33%。死亡率的危险因素是 Oto 评分和接受者的体重指数。