Lung Transplantation in Pediatric Patients Younger than 12 Years: 15-Year Single-Center Experience

Objectives: Pediatric lung transplantation poses unique challenges, from donor shortage to surgical access, intraoperative cardiopulmonary support, and postoperative management. Moreover, experience with pediatric lung transplantation is scarce, especially in patients younger than 12 years. In this study, we present our 15-year experience with lung transplantation in pediatric patients younger than 12 years.

Methods: Records of pediatric (≤18 years old) patients transplanted at our institution between 01/2005 and 09/2020 were retrospectively reviewed. Outcomes were compared between pediatric patients <12 years old versus pediatric patients ≥12 years old. Median (IQR) follow-up was 49 (21–87) months.

Result: During the study period, among the 1,732 lung-transplanted patients, 122 (7%) patients were pediatric, being 44 (36%) patients <12 years old (median age, 8 years, 15 patients being ≤5 years old), and 78 (64%) patients ≥12 years old (median age, 15 years). Patients <12 years old were more often transplanted for primary pulmonary hypertension (39 vs. 12%, p < 0.001). Intraoperatively, patients <12 years old required more often a clamshell approach (41 vs. 18%, p = 0.006) and ECMO support (48 vs. 30%, p = 0.04) than patients ≥12 years old. Need for cardiopulmonary bypass did not differ between groups (27 vs. 15%, p = 0.113, respectively). Postoperative complications such as primary graft dysfunction (PGD) grade 3 at 72 hours (10 vs. 10%, p = 0.96), rethoracotomy for bleeding (12 vs. 11%, p = 0.95), need for hemodialysis (10 vs. 12%, p = 0.73), tracheostomy (25 vs. 18%, p = 0.26), and in-hospital mortality (5 vs. 9%, p = 0.49) did not differ between patients <12 versus ≥12 years old, respectively. Mechanical ventilation time was longer in patients <12 years old (median time, 53 vs. 15 hours, p = 0.008). At 5- and 10-year follow-up, graft survival (%) (79 vs. 76, 79 vs. 60, p = 0.33) and freedom from chronic lung allograft dysfunction (CLAD, %) (81 vs. 62, 61 vs. 59, p = 0.41) did not differ between patients <12 and ≥12 years old, respectively.

Conclusion: Lung transplantation in patients <12 years old is feasible with a postoperative course comparable to patients ≥12 years old, and yields an optimal long-term survival and freedom from CLAD.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021