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Updated: Nov 29, 2025
Left Lung Orthotopic Transplantation in a Juvenile Porcine Model for ESLP
Published on: February 14, 2022
Lung transplantation as an intervention for pediatric pulmonary hypertension
Ernestina Melicoff1, Don Hayes2, Christian Benden3
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Insights
Pediatric lung transplantation is crucial for children with pulmonary hypertension (PH). Early referral and specialized care, including extracorporeal support and bilateral lung transplants, improve outcomes and quality of life for these young patients.
Area of Science:
- Pediatric Pulmonology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Pulmonary hypertension (PH) is a primary indication for lung transplantation in children.
- Current adult-centric listing criteria may delay referral for pediatric PH patients.
- Perioperative management of pediatric PH lung transplant recipients requires multidisciplinary expertise.
Purpose of the Study:
- To review the indications, timing, and management of lung transplantation in pediatric PH.
- To highlight the importance of early referral and specialized perioperative care.
- To discuss outcomes and long-term survival in this patient population.
Main Methods:
- Review of current literature and clinical practices for pediatric lung transplantation in PH.
- Analysis of International Society for Heart and Lung Transplantation (ISHLT) guidelines.
- Discussion of surgical approaches, including bilateral lung transplantation and cardiopulmonary bypass.
- Overview of post-transplant management and outcomes.
Main Results:
- Pediatric PH patients often have preserved cardiac function despite advanced disease, necessitating early referral.
- Bilateral lung transplantation with cardiopulmonary bypass is the standard surgical approach.
- Post-transplant outcomes for pediatric PH patients are comparable to other indications, with superior long-term survival for idiopathic PH.
- Management protocols for immunosuppression and prophylaxis are similar to non-PH transplant recipients.
Conclusions:
- Early referral for pediatric lung transplantation in PH is critical, even if adult criteria are not fully met.
- Multidisciplinary collaboration is essential for successful perioperative and long-term management.
- Lung transplantation offers improved quality of life and excellent long-term survival for pediatric PH patients.
Abstract:
Lung transplantation is a treatment option for selected children with end-stage lung disease and pulmonary vascular disorders. Overall, pulmonary hypertension (PH) is the second most frequent indication for infants and children requiring lung transplants. In pediatric PH patients, timing for listing remains a difficult decision due to patient heterogeneity and varying allocation policies across different countries. Furthermore, perioperative management can be challenging, making interdisciplinary collaboration among surgical, anesthesiology, critical care, and lung transplant teams essential. Because pediatric PH patients typically have preserved cardiac index and exercise tolerance even with advanced disease, they should be referred early even if they do not meet the criteria for listing of primarily adults by International Society for Heart and Lung Transplantation (ISHLT) published in 2015: New York Heart Association (NYHA) functional class III or IV without improvement, cardiac index < 2 L/min/m2 , mean right atrial pressure of >15 mmHg. Bridging strategies with extracorporeal support should be determined at the time of listing in anticipation of possible clinical deterioration. Bilateral lung transplantation using cardiopulmonary bypass to provide hemodynamic stability is nowadays the standard surgical approach in pediatric centers. The immediate post-transplant period is characterized by dramatic changes in the right ventricle (RV) and and left ventricle (LV) anatomy and physiology, which can be life-threatening. Induction, immunosuppression, prophylaxis, and surveillance are not different from patients without PH. Overall, outcomes in pediatric lung and heart-lung transplant patients for PH are not different from those children undergoing transplantation for other indications. In fact, long-term survival is superior in children with idiopathic PH compared to other diseases, providing most recipients with improved quality of life.
