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Long term respiratory outcomes following solid organ transplantation in children: a retrospective cohort study.
  • Marie Wright,
  • Mark Chilvers,
  • Tom Blydt-Hansen
Marie Wright
BC Children's Hospital

Corresponding Author:[email protected]

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Mark Chilvers
BC Children's Hospital
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Tom Blydt-Hansen
BC Children's Hospital
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Background Solid organ transplantation (SOT) has become commonly used in children and is associated with excellent survival rates into adulthood. Data regarding long-term respiratory outcomes following pediatric transplantation are lacking. We aimed to describe the prevalence and nature of respiratory pathology following pediatric heart, kidney, and liver transplant, and identify potential risk factors for respiratory complications. Methods Retrospective review involving all children under active follow-up at the provincial transplant service in British Columbia, Canada, following SOT. Results Of 118 children, 33% experienced respiratory complications, increasing to 54% in heart transplant recipients. Chronic or recurrent cough with persistent chest x-ray changes was the most common clinical picture, and most infections were with non-opportunistic organisms typically found in otherwise healthy children. A history of respiratory illness prior to transplant was significantly associated with risk of post-transplant respiratory complications. 8% were diagnosed with bronchiectasis, which was more common in recipients of heart and kidney transplant. Bronchiectasis was associated with recurrent hospital admissions with lower respiratory tract infections, treatment of acute rejection episodes, and treatment with sirolimus. Interpretation Respiratory morbidity is common after pediatric SOT, and bronchiectasis rates were disproportionately high in this patient group. We hypothesise that this relates to recurrent infections resulting from iatrogenic immunosuppression. Direct pulmonary toxicity from immunosuppression drugs may also be contributory. A high index of suspicion for respiratory complications is needed following childhood SOT, particularly in those with a history of respiratory disease prior to transplant, experiencing recurrent or severe respiratory tract infections, or exposed to intensified immunosuppression.
14 Sep 2021Submitted to Pediatric Pulmonology
14 Sep 2021Submission Checks Completed
14 Sep 2021Assigned to Editor
21 Sep 2021Reviewer(s) Assigned
11 Oct 2021Review(s) Completed, Editorial Evaluation Pending
12 Oct 2021Editorial Decision: Revise Major
09 Jan 20221st Revision Received
10 Jan 2022Assigned to Editor
10 Jan 2022Submission Checks Completed
10 Jan 2022Reviewer(s) Assigned
19 Jan 2022Review(s) Completed, Editorial Evaluation Pending
19 Jan 2022Editorial Decision: Revise Minor
14 Apr 20222nd Revision Received
16 Apr 2022Submission Checks Completed
16 Apr 2022Assigned to Editor
16 Apr 2022Reviewer(s) Assigned
26 Apr 2022Review(s) Completed, Editorial Evaluation Pending
07 May 2022Editorial Decision: Accept
21 May 2022Published in Pediatric Pulmonology. 10.1002/ppul.25968