Comparison of outcomes between living donor and cadaveric lung transplantation in children

Ann Thorac Surg. 1999 Dec;68(6):2279-83; discussion 2283-4. doi: 10.1016/s0003-4975(99)01155-8.


Background: Long-term survival in lung transplant is limited by bronchiolitis obliterans (BOS). We compared outcomes in pediatric living donor bilateral lobar (LL) vs cadaveric lung transplant (CL).

Methods: Children were studied who had LL or CL with at least 1 year follow-up. Data collected included acute rejection episodes, pulmonary function tests (PFT), BOS, and survival. Mean age was 13.36+/-3.16 years in LL and 12.00+/-4.19 years in CL patients (p = 0.37, ns).

Results: There was no difference in rejection (p = 0.41, ns). CL had rejection earlier (2.48+/-3.84 months) than LL (13.60+/-10.74 months; p = 0.02). There was no difference in 12 month PFT. But at 24 months, LL had greater forced expiratory volume in 1 second (FEV1) (p = 0.001) and FEF25-71% (p = 0.01) than CL. BOS was found in 0/14 LL vs 9/11 (82%) CL after 1 year (p = 0.04). After 2 years, 0/8 LL and 6/7 (86%) CL had BOS (p < 0.05). LL had 85% survival vs 79% for CL at 12 months. At 24 months, LL survival was 77% vs 67% for CL.

Conclusions: Pediatric LL had less BOS and better pulmonary function than CL. As BOS is a determinant of long-term outcome, we believe LL is the preferred lung transplant method for children.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Bronchiolitis Obliterans / etiology
  • Cadaver
  • Child
  • Female
  • Forced Expiratory Volume
  • Graft Rejection
  • Humans
  • Living Donors*
  • Lung Transplantation* / adverse effects
  • Lung Transplantation* / mortality
  • Male
  • Maximal Midexpiratory Flow Rate
  • Survival Rate