Risk Factors for Acute Rejection in Pediatric Lung Transplantation and Its Impact on Graft Failure

BACKGROUND: Although acute rejection is a common complication of lung transplantation, few studies have analyzed risk factors for acute rejection in pediatric lung transplant patients. The purpose of this study was to examine risk and protective factors for acute rejection in pediatric lung transplantation and its impact on graft failure. METHODS: A retrospective analysis was performed on lung transplant data for a cohort of 906 pediatric patients from the Organ Procurement and Transplantation Network (OPTN) Database between October 1, 1987, and June 30, 2023. Multivariable logistic regression was conducted to identify risk and protective factors for acute rejection, adjusting for induction and maintenance therapy agents. Multivariable Cox proportional hazards regression analysis was performed to evaluate the impact of acute rejection on graft failure. RESULTS: Multivariable logistic regression analysis identified cyclosporine maintenance therapy (adjusted OR, 4.26; 95% CI, 2.89-6.27), ischemia time ≥ 9 h (adjusted OR, 4.73; 95% CI, 1.25-17.85), and two mismatches at the HLA-A locus (adjusted OR, 1.42; 95% CI, 1.02-1.96) as significant risk factors for acute rejection. Recipient Hispanic ethnicity (adjusted OR, 0.56; 95% CI, 0.35-0.91) and antithymocyte globulin induction therapy (adjusted OR, 0.55; 95% CI, 0.36-0.85) were significant protective factors. Acute rejection was independently associated with graft failure. CONCLUSION: We identified risk and protective factors for acute rejection in pediatric lung transplant recipients. Findings from this study will contribute to the current understanding of recipient and donor characteristics that may impact rejection risk.