Related Experiment Video
Updated: Aug 4, 2026
Study of Experimental Organ Donation Models for Lung Transplantation
Published on: March 15, 2024
Comparison of outcomes between living donor and cadaveric lung transplantation in children
V A Starnes1, M S Woo, E F MacLaughlin
1Division of Cardiothoracic Surgery, Childrens Hospital Los Angeles, California 90027, USA. vstarnes@chla.usc.edu
Insights
Pediatric lung transplant outcomes improved with living donor lobar (LL) transplants compared to cadaveric lung transplants (CL). LL reduced bronchiolitis obliterans (BOS) and enhanced pulmonary function, suggesting it is a preferred method for children.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Transplantation immunology
Background:
- Bronchiolitis obliterans (BOS) limits long-term survival after lung transplantation.
- Pediatric lung transplant outcomes are a critical area of research.
Purpose of the Study:
- To compare outcomes between pediatric living donor bilateral lobar (LL) lung transplants and cadaveric lung transplants (CL).
- To evaluate the impact of transplant type on acute rejection, pulmonary function, BOS development, and survival rates.
Main Methods:
- Retrospective study of pediatric patients undergoing LL or CL with at least one year of follow-up.
- Data collection included acute rejection episodes, pulmonary function tests (PFTs), BOS diagnosis, and survival rates.
- Patient cohorts were compared based on mean age, rejection timing, PFTs (FEV1, FEF25-71%), BOS incidence, and survival at 12 and 24 months.
Main Results:
- No significant difference in overall acute rejection rates between LL and CL groups (p=0.41).
- Cadaveric lung transplant (CL) recipients experienced earlier acute rejection (2.48 months) compared to living donor lobar (LL) recipients (13.60 months; p=0.02).
- At 24 months post-transplant, LL recipients showed significantly better pulmonary function (FEV1, FEF25-71%; p<0.01) and a lower incidence of BOS (0% vs 82-86%; p<0.05) compared to CL recipients.
- Survival rates at 24 months were higher for LL (77%) than for CL (67%).
Conclusions:
- Pediatric living donor bilateral lobar (LL) lung transplantation is associated with reduced bronchiolitis obliterans (BOS) and improved pulmonary function compared to cadaveric lung transplants (CL).
- Given that BOS is a major determinant of long-term outcomes, LL is recommended as the preferred lung transplant method for pediatric patients.
- These findings support the advancement of living donor lung transplantation in pediatric care.
Background:
Long-term survival in lung transplant is limited by bronchiolitis obliterans (BOS). We compared outcomes in pediatric living donor bilateral lobar (LL) vs cadaveric lung transplant (CL).
Methods:
Children were studied who had LL or CL with at least 1 year follow-up. Data collected included acute rejection episodes, pulmonary function tests (PFT), BOS, and survival. Mean age was 13.36+/-3.16 years in LL and 12.00+/-4.19 years in CL patients (p = 0.37, ns).
Results:
There was no difference in rejection (p = 0.41, ns). CL had rejection earlier (2.48+/-3.84 months) than LL (13.60+/-10.74 months; p = 0.02). There was no difference in 12 month PFT. But at 24 months, LL had greater forced expiratory volume in 1 second (FEV1) (p = 0.001) and FEF25-71% (p = 0.01) than CL. BOS was found in 0/14 LL vs 9/11 (82%) CL after 1 year (p = 0.04). After 2 years, 0/8 LL and 6/7 (86%) CL had BOS (p < 0.05). LL had 85% survival vs 79% for CL at 12 months. At 24 months, LL survival was 77% vs 67% for CL.
Conclusions:
Pediatric LL had less BOS and better pulmonary function than CL. As BOS is a determinant of long-term outcome, we believe LL is the preferred lung transplant method for children.
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