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Functional, Volumetric, and Growth Outcomes After Pediatric Bilateral Lung Transplantation
Seon Yong Bae1, Samina Park1, Dae Hyeon Kim1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Insights
Pediatric lung transplantation shows good long-term recovery, with children experiencing improved lung function and growth. Outcomes are similar for both age groups and graft types, supporting the use of size-reduced grafts.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Transplantation Immunology
Background:
- Long-term outcomes of pediatric lung transplantation require further evaluation.
- Assessing functional recovery, lung volume adaptation, and growth is crucial for pediatric recipients.
Purpose of the Study:
- To evaluate long-term functional recovery, volumetric adaptation, and growth in pediatric lung transplant recipients.
- To compare outcomes based on recipient age and lung graft type.
Main Methods:
- Retrospective, single-center study of 16 pediatric lung transplant recipients (<18 years).
- Analysis of perioperative data, pulmonary function, CT-derived lung volumes, somatic growth, and survival.
- Kaplan-Meier survival analysis for overall survival (OS) and chronic lung allograft dysfunction (CLAD)-free survival.
Main Results:
- No significant difference in OS or CLAD-free survival between younger (≤10 years) and older (>10 years) recipients.
- CT volumetry showed progressive lung expansion with similar trajectories across age groups and graft types (lobar vs. whole-lung).
- Significant postoperative growth improvement observed, with catch-up growth in many recipients.
Conclusions:
- Pediatric lung transplantation leads to favorable long-term functional recovery, lung volume adaptation, and growth restoration.
- Outcomes are comparable between lobar and whole-lung grafts, supporting the use of size-reduced grafts when necessary.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
