Functional, Volumetric, and Growth Outcomes After Pediatric Bilateral Lung Transplantation

Long-term multidimensional evaluations of pediatric lung transplantation are limited. This study assessed the functional recovery, volumetric adaptation, and growth in pediatric recipients by comparing age and graft type.

This single-center, retrospective, descriptive study longitudinally reviewed 16 children (age < 18 years) who underwent bilateral deceased-donor lung transplantation. Perioperative characteristics, pulmonary function, computed tomography (CT)-derived lung volume, somatic growth, and survival were analyzed. Overall survival (OS) and chronic lung allograft dysfunction (CLAD)-free survival were estimated using the Kaplan-Meier method, and longitudinal physiological and developmental patterns were assessed descriptively.

In the younger group (≤ 10 years, n = 7) and the older group (> 10 years, n = 9), lobar transplantation was performed in 5 (71.4%) and 3 (33.3%) patients, respectively. CLAD was diagnosed in 1 younger recipient (14.3%) and 2 older recipients (22.2%). OS did not differ significantly between age groups (log-rank p = 0.96), and CLAD-free survival was comparable (log-rank p = 0.73). CT volumetry demonstrated progressive postoperative lung expansion with similar temporal trajectories across age groups and between lobar and whole-lung grafts. Growth patterns demonstrated meaningful postoperative improvement, with many children who exhibited faltering pretransplant growth demonstrating catch-up toward individualized percentile curves.

Pediatric lung transplantation results in favorable long-term recovery, including functional improvement, durable volumetric adaptation, and partial restoration of growth dynamics. Comparable outcomes between lobar and whole-lung grafts support the use of size-reduced grafts in cases of donor-recipient mismatch.