Abstract:

Objective To summarize the clinical characteristics of 9 children who underwent lung transplantation, explore the prognosis and immune profiles of these children, and furnish references for clinical diagnosis and treatment. Methods A retrospective analysis was conducted on the clinical data and prognosis of 9 children who underwent lung transplantation and were hospitalized in our hospital from January 2019 to June 2023. Results Among the 9 children, 3 were male and 6 were female. The underlying diseases comprised pulmonary fibrosis, idiopathic pulmonary arterial hypertension, obliterative bronchiolitis, interstitial lung disease, and cystic fibrosis. All children underwent bilateral lung transplantation, with an average age of 7.83 (4.79 - 9.34) years at the time of transplantation. Four children developed bronchial stenosis, among which all 3 children were under 7 years old and 2 were diagnosed with bronchiolitis obliterans syndrome (BOS) related to chronic allograft dysfunction. Compared with the normal reference values, the proportions of CD3⁺T and CD8⁺T cells were elevated in six children, and the proportions of CD4⁺T cells and CD4⁺T/CD8⁺T were decreased in four and eight children, respectively. Immune abnormalities were more pronounced in children under 7 years old. Two children with BOS developed post-transplant lymphoproliferative disorder (PTLD), and both were diagnosed with diffuse large B-cell lymphoma through biopsy. The follow-up period was 2.67 (1.67-3.17) years. Two children with BOS died at 1.33 years and 1 year after transplantation, both succumbing to typeⅡ respiratory failure. All children over the age of seven were taking oral immunosuppressive drugs at home and were capable of performing simple physical activities and daily life. Conclusion BOS and PTLD are life-threatening complications for children under 7 years old who have undergone bilateral lung transplantation, being closely associated with abnormal T lymphocyte subsets. The survival period after lung transplantation is shorter for younger children, and their lung structure and immune status are key factors influencing prognosis. With the increasing number of children undergoing lung transplantation, it is necessary to further expand the case numbers and deepen age group studies to optimize clinical diagnosis and treatment strategies, prolong the survival period of children, and enhance their quality of life.

Key words: lung transplantation, child, immune status, prognosis