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Outcome of infants listed for lung or heart/lung transplantation
P S Ro1, T L Spray, N D Bridges
1Department of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, 19104, USA.
Insights
Infants undergoing lung or heart/lung transplantation show similar outcomes to older children. Earlier diagnosis and listing for pediatric lung transplantation can improve pre-transplant survival rates.
Area of Science:
- Pediatric critical care medicine
- Cardiothoracic surgery
- Transplant immunology
Background:
- Limited data exists on the outcomes, characteristics, and organ availability for infants requiring lung or heart/lung transplantation.
- Understanding these factors is crucial for optimizing transplant candidacy and management in this vulnerable population.
Purpose of the Study:
- To compare the outcomes of infants (under 1 year) versus older children (over 1 year) listed for primary lung or heart/lung transplantation.
- To identify factors influencing pre-transplant mortality and post-transplant survival in pediatric lung transplant candidates.
Main Methods:
- A retrospective analysis of pediatric patients listed for primary lung or heart/lung transplantation at a single institution over 45 months.
- Comparison of outcomes between infants (<1 year) and children (>1 year) who either received a transplant or died before transplantation.
Main Results:
- Infants had significantly shorter waiting times for organs compared to children.
- While there was a trend toward poorer pre-transplant survival in infants, post-transplant outcomes including 1-year survival were comparable.
- Infants experienced longer hospitalizations post-transplant.
Conclusions:
- Infant age should not be a contraindication for lung or heart/lung transplantation, as outcomes are similar to older children.
- Earlier diagnosis and prompt listing for transplantation in infants may reduce pre-transplant mortality.
Background:
Little is known about outcome, characteristics, or organ availability for infants listed for lung or heart/lung transplantation.
Methods:
Within a 45-month period at one institution, all pediatric patients who were listed for primary lung or heart/lung transplantation and who reached the end point of either transplant or death prior to transplant were identified. Outcomes for those patients listed as younger than and older than 1 year of age were compared.
Results:
Among 48 pediatric patients, 19 were infants less than one year of age. The median age among infants at listing was 3.7 months (range 0.5 to 8.9 months). Death before transplant occurred in 10 of 19 infants (53%) compared with 14 of 29 (48%) children. When comparing those infants who died prior to transplant with those who received organs, there were no significant differences with respect to size, blood type, age at listing, presence of pulmonary hypertension, or type of transplant for which the patient was listed. There was a trend toward poorer pre-transplant survival for infants when compared with children. Waiting times were significantly shorter for infants vs children (p = 0.02). The incidence of acute cellular rejection and serious infection was similar in the 2 groups. Infants had significantly longer hospitalization post-transplant and a trend toward poorer hospital survival, although survival at 1 year was comparable between the 2 groups.
Conclusion:
The outcome for infants listed for lung or heart/lung transplantation is similar to that of children; thus, very young age should not be considered a contraindication to lung or heart/lung transplantation. Earlier diagnosis and listing may decrease pre-transplant mortality.