Long-Term Outcomes After Lung Transplantation in Children With Intellectual Disabilities

Area of Science:

• Pediatric Pulmonology
• Transplant Surgery
• Developmental Pediatrics

Background:

• The United Network for Organ Sharing (UNOS) began collecting data on intellectual disability status in 2008.
• Long-term outcomes for pediatric lung transplant recipients with intellectual disabilities (IDs) have not been well-characterized.

Purpose of the Study:

• To analyze the impact of intellectual disability on long-term outcomes in children undergoing bilateral lung transplantation.
• To determine if cognitive status influences graft survival and other post-transplant metrics.

Main Methods:

• Retrospective analysis of 504 pediatric patients (<18 years) who underwent bilateral lung transplantation using UNOS data (March 2008 - December 2022).
• Patients were categorized into: no cognitive delay, possible cognitive delay, and definite cognitive delay.
• Multivariate Cox proportional hazards modeling assessed the effect of cognitive disability on 3-year graft survival.

Main Results:

• Of 504 patients, 12% had definite cognitive delay, 5% had possible delay, and 83% had no delay.
• No significant differences were observed in 60-day graft survival (p=0.4), 3-year graft survival (p=0.6), causes of death (p=0.24), or rejection treatment (p=0.06) among the groups.
• Graft survival at 3 years was not significantly impacted by the presence or severity of cognitive delay.

Conclusions:

• Intellectual disability is not associated with inferior long-term graft survival after pediatric bilateral lung transplantation.
• Cognitive status should not be a contraindication for bilateral lung transplantation based on graft survival outcomes.
• Further research may explore other factors influencing outcomes in this population.