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.
Between the Rock and Hard Place: The Evaluation of a Patient With a History of Cancer for Solid Organ Transplantation