En-Bloc Versus Bilateral Sequential Technique for Pediatric Lung Transplantation

Area of Science:

• Pediatric surgery
• Thoracic surgery
• Transplantation medicine

Background:

• Lung transplantation is the primary treatment for pediatric end-stage lung disease.
• Bilateral sequential lung transplantation (BSLT) is the predominant method in the US.
• En-bloc lung transplantation (EBLT) was proposed to mitigate bronchial anastomosis complications in younger children.

Purpose of the Study:

• To compare the outcomes of EBLT and BSLT in pediatric lung transplantation.
• To evaluate survival and complication rates between the two surgical techniques.
• To assess the efficacy of EBLT in younger pediatric patients (≤5 years).

Main Methods:

• A retrospective analysis of the United Network for Organ Sharing dataset (2002-2021).
• Inclusion of pediatric patients (≤18 years) undergoing bilateral lung transplantation.
• Comparison of demographic, clinical characteristics, and survival data between EBLT and BSLT groups.

Main Results:

• EBLT was used in 8.7% of 919 pediatric lung transplants.
• EBLT recipients were younger and more likely to be on mechanical ventilation.
• No significant difference in survival or re-transplantation rates between EBLT and BSLT.
• EBLT demonstrated lower rates of airway dehiscence and bronchiolitis obliterans.
• Surgical technique was not an independent risk factor for survival.

Conclusions:

• En-bloc lung transplantation (EBLT) is associated with reduced airway complications compared to bilateral sequential lung transplantation (BSLT) in children.
• Both EBLT and BSLT offer comparable long-term survival outcomes in pediatric lung transplant recipients.
• EBLT is a viable alternative surgical approach for pediatric lung transplantation, particularly regarding airway health.