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Improved Outcomes of Infant Lung Transplantation Over 3 Decades
Horacio G Carvajal1, Taylor C Merritt1, Matthew W Canter1
1Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri.
Insights
Infant lung transplantation outcomes have improved significantly over three decades. Carefully selected infants show promising short- and long-term survival and functional status after lung transplants.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Transplantation Medicine
Background:
- Lung transplantation is a critical treatment for end-stage lung disease in children.
- Infants represent a small fraction of pediatric lung transplant cases.
- This study analyzes infant lung transplant outcomes over 31 years using linked UNOS and PHIS data.
Purpose of the Study:
- To provide a comprehensive overview of infant lung transplantation outcomes.
- To identify factors influencing survival and functional status in infant lung transplant recipients.
- To evaluate trends in infant lung transplantation over three decades.
Main Methods:
- Review of infant lung transplantations from 1989-2020 using United Network for Organ Sharing (UNOS) data.
- Linking UNOS and Pediatric Health Information System (PHIS) records for patients transplanted from 1995-2020.
- Assessment of diagnoses, extracorporeal membrane oxygenation (ECMO) support, survival to discharge, hospital experience, operative decade, bronchiolitis obliterans syndrome (BOS), long-term survival, and functional status.
Main Results:
- 112 lung transplants were performed in 109 infants over 31 years.
- Hospital survival was lower for infants with idiopathic pulmonary hypertension and those transplanted at less experienced centers.
- Post-discharge median survival was 10.3 years, with significantly improved 10-year survival in the most recent decade (2010-2020).
- 84.6% of survivors had minor or no functional restrictions.
Conclusions:
- Infant lung transplantation outcomes have improved over time.
- Carefully selected infants demonstrate promising short- and long-term results following lung transplantation.
- Further research into optimizing outcomes for high-risk infant populations is warranted.
Background:
Lung transplantation is the definitive surgical treatment for end-stage lung disease. However, infants comprise less than 5% of pediatric cases. This study sought to provide an overview of infant lung transplantation outcomes over the past 3 decades by using linked United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) data.
Methods:
Infants undergoing lung transplantation from 1989 to 2020 in UNOS were reviewed. UNOS and PHIS records for patients who underwent lung transplantation from 1995 to 2020 were linked using date of birth, sex, and date of surgery ± 3 days. The study assessed underlying diagnoses, pretransplant and posttransplant extracorporeal membrane oxygenation support, retransplant-free survival to discharge, hospital experience (≥1 annual transplant for ≥4 years in a 5-year period), operative decade, bronchiolitis obliterans syndrome, long-term survival, and functional status at latest follow-up.
Results:
A total of 112 lung transplants were performed in 109 infants over 31 years. Of these, 21 patients died before discharge, and 2 underwent repeat transplantation during the same admission. The study linked 80.6% (83 of 103) of UNOS and PHIS records. Hospital survival was lower for infants with idiopathic pulmonary hypertension and those who underwent transplant procedures at less experienced centers. All 7 infants requiring postoperative extracorporeal membrane oxygenation support died. Median freedom from bronchiolitis obliterans syndrome was 8.1 years (interquartile range, 4.6 to 11.6 years). After discharge, median survival was 10.3 years (interquartile range, 6.3 to 14.4 years), with improved 10-year survival for those patients who underwent transplantation from 2010 to 2020 (87.3%) vs 2000 to 2009 (52.4%; P = .098) and 1989 to 1999 (34.1%; P = .004). A total of 84.6% (33 of 39) of survivors had minor or no restrictions at latest follow-up.
Conclusions:
Carefully selected infants experience promising short- and long-term outcomes after lung transplantation.
