Pediatric Lung Transplantation Following Non-Transplant Cardiac Surgery: A Contemporary Analysis

Area of Science:

• Pediatric Cardiology
• Thoracic Surgery
• Transplantation Medicine

Background:

• Increasing numbers of children undergo cardiac surgery, potentially affecting future thoracic surgery outcomes.
• Outcomes for pediatric lung transplantation (LTx) following prior cardiac surgery are not well-established.

Purpose of the Study:

• To investigate the impact of previous cardiac surgery on outcomes in pediatric lung transplant recipients.
• To analyze post-lung transplant results in children with and without a history of cardiac surgery.

Main Methods:

• Retrospective analysis of the Scientific Registry of Transplant Recipients (SRTR) database.
• Inclusion of first-time pediatric LTx candidates from 2003-2024, excluding prior cardiothoracic transplantation.
• Utilized univariate analyses, multivariable Cox regression, and Kaplan-Meier plots for comprehensive assessment.

Main Results:

• Identified 1333 LTx candidates without and 144 with prior cardiac surgery.
• Children with prior congenital cardiac surgery showed significantly higher waitlist mortality (31%) and worse long-term outcomes (HR 1.89).
• Prior non-congenital cardiac surgery did not adversely affect short- or long-term post-LTx outcomes in pediatric recipients.

Conclusions:

• An increasing trend of pediatric lung transplantation in patients with prior cardiac surgery, particularly congenital heart disease, is observed.
• Congenital cardiac surgery history is linked to poorer lung transplant outcomes and higher waitlist mortality.
• Non-congenital cardiac surgery history does not appear to be a significant risk factor for pediatric lung transplant outcomes.