Risk Factors for Bronchiolitis Obliterans Syndrome in Pediatric Lung Transplant Recipients

Purpose The purpose of this study is to describe the survival of pediatric patients who develop bronchiolitis obliterans syndrome (BOS) after lung transplant (LTx) and to identify the risk factors leading to the diagnosis. Methods The UNOS Registry was queried to identify pediatric LTx recipients (age Results 900 lung transplant recipients were identified. 48% (n=431) of these patients were diagnosed with BOS in the post-transplant period. These patients developed BOS after a median of 4.6 years (95% CI: 4.3-5.0). Compared to non-BOS patients, those who developed BOS were less often infants (9% vs. 15%, p=0.008), more frequently aged 2-11yrs (28% vs. 22%, p=0.049), less frequently ventilator dependent at time of LTx (14% vs. 22%, p=0.001), and more frequently experienced graft rejection within 1-yr post-LTx (38% vs. 23%, p Conclusion BOS remains a significant cause of mortality in children after LTx. Adolescent age, OB (non-retransplant) diagnosis, and graft rejection within 1-yr post-LTx are significant predictors of developing BOS. Early development of BOS (within 3yrs post-LTx) resulted in significantly worse graft survival than later development.