Scoliosis progression after lung transplantation.

Abstract

Background context: Scoliosis is a potential postoperative complication of various pediatric cardiothoracic conditions.

Purpose: To investigate the incidence of scoliosis in pediatric lung transplant patients and explore the factors associated with its development.

Study design: Retrospective observational study.

Patient sample: About 330 consecutive lung transplant recipients at a single institution between April 2002 and June 2022.

Outcome measures: The incidence of scoliosis.

Methods: After excluding 45 patients with <1 year of follow-up, 285 patients were analyzed: 43 pediatric (≤17 years) and 242 adult (>18 years) patients. Data on baseline demographics, Cobb angle measurements pre- and posttransplant, and lung volumes at 1-year posttransplant in pediatric patients were collected. The prevalence of scoliosis was compared between pediatric and adult patients. Additionally, the impact of lung volume differences (right minus left) on scoliosis progression was assessed.

Results: Pediatric (n=43) and adult (n=242) patients had a mean age of 10.3 and 44.9 years, respectively. Scoliosis was significantly more prevalent in pediatric patients, with 30.2% having a Cobb angle >10° and 13.9% having a Cobb angle >20°, compared to 11.5% and 1.6% in adults, respectively. Pediatric patients with Cobb angles >20° exhibited significant lung volume differences 1-year posttransplant. Lung volume disparities increased the risk of scoliosis progression, particularly in patients with unilateral lung collapse.

Conclusions: Pediatric lung transplant recipients have a higher incidence of significant scoliosis than adult recipients. Posttransplant lung volume disparities, especially in cases of unilateral lung collapse, may contribute to scoliosis progression. Routine spinal assessments are necessary for managing scoliosis in pediatric lung transplant patients to prevent curvature progression and ensure long-term musculoskeletal health.