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Updated: Jun 24, 2026
Left Lung Orthotopic Transplantation in a Juvenile Porcine Model for ESLP
Published on: February 14, 2022
Lung and heart-lung transplantation in children and adolescents: a long-term single-center experience
Heidi Görler1, Martin Strüber, Manfred Ballmann
1Department of Cardiothoracic, Hannover Medical School, Germany. goerler.adelheid@mh-hannover.de
Insights
Pediatric lung transplantation (LTx) is a viable option for children with end-stage lung disease, offering improved survival despite challenges. Experienced teams can overcome donor organ limitations using reduced-size grafts for better outcomes.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Transplantation Medicine
Background:
- Pediatric lung transplantation (LTx) presents unique challenges due to immunosuppression risks and long-term prognosis.
- A retrospective analysis of 53 lung and heart-lung transplantations (HLTx) in children was conducted.
Purpose of the Study:
- To analyze the outcomes of pediatric lung and heart-lung transplantations.
- To identify key indications, survival rates, and causes of mortality.
- To assess pediatric-specific challenges compared to adult transplantations.
Main Methods:
- Retrospective analysis of 37 lung and 16 heart-lung transplantations in pediatric patients (<18 years).
- Evaluation of transplant indications, survival data, and mortality causes.
- Comparison of pediatric-specific challenges with adult lung transplantation.
Main Results:
- Thirty-day mortality was 13.2%.
- Kaplan-Meier survival rates at 1, 3, 5, and 10 years were 69%, 64%, 44%, and 39%, respectively.
- Cystic fibrosis and congenital heart disease with Eisenmenger syndrome were primary indications; infection and graft failure were main causes of death. Reduced-size grafts were used in 42% of double-lung transplantations without impacting survival.
Conclusions:
- Pediatric lung transplantation is feasible and effective for end-stage pulmonary disease when performed by experienced teams.
- Reduced-size donor organs can address the scarcity of pediatric organs.
- Managing pediatric-specific complications and therapeutic needs is crucial for successful long-term outcomes.
Background:
Pediatric lung transplantation (LTx) remains a challenge for a highly selected group of patients. The requirements for immunosuppressive therapy and the associated risks must be weighed against the long-term prognosis of this operation. Therefore, we retrospectively analyzed our experience after 53 lung and heart-lung transplantations (HLTx) in children.
Methods:
All pediatric patients <18 years of age who underwent LTx (n = 37) and HLTx (n = 16) at our institution were included in this study. We analyzed indications for transplantation, survival rates and causes of death. Herein we assess pediatric-specific challenges in comparison to adults.
Results:
Thirty-day mortality was 13.2%. Kaplan-Meier survival rates at 1, 3, 5 and 10 years were 69%, 64%, 44% and 39%, respectively. Main indications for transplantation were cystic fibrosis and congenital heart disease with Eisenmenger syndrome. Other diagnoses were retransplantation, primary pulmonary hypertension and pulmonary fibrosis. The main causes of death were infection and chronic graft failure. Reduced-size transplantation was performed in 42% of double-lung transplantation (DLTx) patients without negatively impacting survival. Six patients received pulmonary retransplantation, 1 of whom died early.
Conclusions:
Pediatric transplantation is a feasible therapeutic option when undertaken by an experienced team. It should be offered to the small patient population suffering from end-stage pulmonary disease. The limited number of pediatric donor organs can be overcome by using reduced-size organs. However, the management of pediatric-specific complications and therapeutic requirements is essential for positive long-term results after LTx in these patients.
