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Is lung transplantation survival better in infants? Analysis of over 80 infants
Muhammad S Khan1, Jeffrey S Heinle, Andres X Samayoa
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX77030, USA. mshoaibkhan@hotmail.com
Insights
Infants undergoing lung transplantation (LTx) have similar long-term graft survival compared to older children. Conditional 1-year survival for infants is notably higher, suggesting favorable outcomes in this young population.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Critical care medicine
Background:
- Over 1,600 pediatric lung transplantations (LTx) performed globally, with improving outcomes.
- Infant LTx (≤ 12 months) is rare (<4/year), primarily in the USA.
- Limited multi-institutional data exists on infant LTx outcomes.
Purpose of the Study:
- To evaluate and document infant lung transplant outcomes longitudinally.
- To compare infant LTx survival rates with those of other pediatric age groups.
- To identify factors influencing survival in infant lung transplantation.
Main Methods:
- Utilized the United Network of Organ Sharing database (1987-2011).
- Analyzed 84 infant LTx cases out of 1,003 pediatric LTx.
- Excluded combined organ transplantations.
Main Results:
- Infants (median age 4 months) underwent primarily bilateral LTx (95%).
- Overall Kaplan-Meier graft survival was similar between infants and other pediatric recipients (half-life 4.0 vs 3.4 years).
- Conditional 1-year survival was significantly higher for infants (half-life 7.4 vs 5.0 years). Increased center experience was associated with better survival.
Conclusions:
- Infant lung transplantation demonstrates comparable long-term outcomes to older pediatric recipients.
- Infants show improved conditional 1-year graft survival post-transplantation.
- Center experience is a significant factor in infant lung transplant success.
Background:
There have been >1,600 pediatric lung transplantations (LTx) performed worldwide with a trend toward improved outcomes over the last 25 years. The majority of these LTxs have been in older children and adolescents. Less than 4 infant (defined as ≤ 12 months of age) LTxs per year have been performed over the past 20 years, mostly in the USA. However, infant LTx outcomes have not been well documented in a multi-institutional longitudinal fashion.
Methods:
The United Network of Organ Sharing database was queried from October 1987 to July 2011. Of the 1,003 pediatric LTxs reported, 84 (8%) were infants. All combined transplantations were excluded.
Results:
Eighty-one infants received 84 LTxs, of which 95% had a bilateral LTx. Median age and weight at LTx was 4 months (range 0 to 11 months) and 5.3 kg (2.7 to 11.8 kg), respectively. Median ischemic time was 5.2 hours (2.0 to 10.8 hours). Overall Kaplan-Meier graft survival was similar for infants compared with other pediatric age group (OPA: >1 to 18 years) LTx recipients (half-life 4.0 years vs 3.4 years, p = 0.7). Conditional 1-year graft survival for infants was significantly higher than OPA (half-life 7.4 years vs 5.0 years, p = 0.024). Early (1987 to 2000, n = 46) and late (2001 to 2011, n = 38) era graft survival was not significantly different. Graft survival in pre-LTx ventilated infants was significantly better than pre-LTx ventilated OPA (half-life 6.1 years vs 0.9 year, p = 0.004) and was not statistically different from pre-LTx infants not on ventilatory support (half-life 6.1 years vs 2.2 years, p = 0.152). Cox regression of 5 variables (weight, donor arterial PO(2), pre-Tx ventilator, organ ischemic time, center experience) showed that survival was associated with increased center experience (p = 0.03).
Conclusion:
Infants undergoing LTx have outcomes similar to those of all other pediatric LTx patients.
