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ECMO Bridge to Lung Transplant in Children with Idiopathic Pulmonary Arterial Hypertension
Hosam F Ahmed1, David L S Morales1, Don Hayes2
1Heart Institute and Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Insights
Fewer children with idiopathic pulmonary arterial hypertension (IPAH) receive lung transplants (LTx) despite severe disease. This study found that pediatric IPAH patients on ECMO at LTx had comparable survival rates to other pediatric ECMO patients, supporting expanded LTx consideration.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Pulmonary Medicine
Background:
- Idiopathic pulmonary arterial hypertension (IPAH) is a significant reason for pediatric lung transplantation (LTx).
- Recent trends indicate a decline in LTx for children with IPAH, even those with severe disease.
- Investigating the impact of extracorporeal membrane oxygenation (ECMO) on post-LTx survival in pediatric IPAH patients is crucial.
Discussion:
- This study analyzed UNOS Registry data for pediatric LTx recipients on ECMO at the time of transplant.
- A total of 74 pediatric LTx recipients on ECMO were identified, with 12 diagnosed with IPAH.
- Children with IPAH undergoing LTx while on ECMO demonstrated survival rates comparable to those on ECMO for other conditions.
Key Insights:
- Pediatric IPAH patients on ECMO at LTx show comparable survival to other pediatric ECMO patients.
- These findings support the potential for expanding LTx eligibility for pediatric IPAH patients.
- The number of pediatric IPAH patients undergoing LTx remains low, necessitating further guidance.
Outlook:
- Encouraging results suggest LTx could be a viable option for more pediatric IPAH patients on ECMO.
- Development of a consensus document is recommended to guide referral and selection of high-risk pediatric IPAH patients on ECMO for LTx.
- Further research may refine criteria for selecting pediatric IPAH patients for LTx while on ECMO.
Abstract:
Idiopathic pulmonary arterial hypertension (IPAH) represents an important clinical indication for lung transplant (LTx) in children. Recent trends show fewer children with IPAH are undergoing LTx nowadays compared to previous time periods, including those with most severe form of the disease. Using the UNOS Registry, we investigated if ECMO at the time of transplant impacts post-transplant survival in children with IPAH. A total of 74 LTx recipients while on ECMO at the time of transplant were identified (IPAH: N = 12). Children with IPAH who underwent LTx while on ECMO had shown comparable survival rates to those who were on ECMO for other conditions. This analysis provides encouraging results, supporting the potential expansion of LTx for this patient population. Given the low number of children undergoing LTx, we think there should be a consensus document to provide better guidance for referring and selecting the high-risk pediatric population with IPAH on ECMO for lung transplant.
