Lung transplantation in adolescents

Mario Nosotti, Letizia Corinna Morlacchi, Valeria Rossetti, Valeria Musso, Lorenzo Rosso


Background: Adolescence is a very peculiar age period, due to physical and psychological changes from childhood to maturity. Adolescents undergoing lung transplantation seem to be at higher risk of acute and chronic rejection, and, despite their young age, they have poorer outcomes when compared to older recipients. Our study describes a 10 years’ experience in a lung transplantation center in Italy.
Methods: We analysed data from our institutional database dedicated to lung transplantation. We extracted data regarding lung transplanted patients from January 1st 2008 to March 1st 2019. We compared adolescents (10–24 years old, Group A) and older recipients (≥25 years, Group C), particularly in terms of chronic lung allograft dysfunction (CLAD) and survival.
Results: Our cohort included 223 patients; 14.8% of them were adolescents. Cystic fibrosis was the most common indication for transplant in Group A (94% vs. 41% in Group C). The difference in overall survival and CLAD-free survival was not statistically different between adolescents and older patients.
Conclusions: The analysis on overall survival and CLAD-free survival did not show difference between our two groups. These results, in contrast with different previously published articles, could be the consequence of a limited sample size, or a geographical bias, since those studies were based on patients from USA. Also, we hypothesize that bacterial colonization in cystic fibrosis patients may cause a development in the immune system at a younger age, compared to other patients.