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Heart-lung transplantation for patients under 10 with cystic fibrosis
I M Balfour-Lynn1, I Martin, B F Whitehead
1Transplant Unit, Great Ormond Street Hospital for Children NHS Trust, London.
Insights
Younger cystic fibrosis patients (under 10) show similar heart-lung transplant outcomes and survival rates compared to older children. Pediatricians should confidently refer these younger patients for transplantation assessment.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Cystic Fibrosis Research
Background:
- Cystic fibrosis (CF) significantly impacts multiple organ systems, including the heart and lungs.
- Heart-lung transplantation is a critical treatment option for end-stage CF-related cardiopulmonary disease.
- The efficacy and safety of heart-lung transplantation in very young children with CF remain an area of active investigation.
Purpose of the Study:
- To compare the outcomes of heart-lung transplantation assessment in pediatric patients with cystic fibrosis aged under 10 years versus older children.
- To evaluate the impact of age on waiting list placement, transplant receipt, and post-transplantation survival in this cohort.
- To provide evidence-based guidance for pediatricians regarding referrals for heart-lung transplantation in young CF patients.
Main Methods:
- Retrospective analysis of pediatric patients with cystic fibrosis referred for heart-lung transplantation assessment.
- Comparison of patient groups based on age: under 10 years versus older children.
- Evaluation of key outcome metrics including waiting list placement rates, transplant rates, and survival at three years post-transplantation.
Main Results:
- Similar proportions of younger (64%) and older (71%) CF patients were placed on the active waiting list.
- Transplant receipt rates were comparable between the younger (35%) and older (31%) groups.
- Three-year post-transplantation survival (41% vs. 46%) and overall survival for those on the active list (27% vs. 29%) were similar across age groups.
Conclusions:
- Age under 10 years is not a contraindication for heart-lung transplantation assessment in pediatric cystic fibrosis patients.
- Similar outcomes support the consideration of heart-lung transplantation for younger children with advanced CF.
- Pediatricians should be encouraged to refer eligible younger CF patients for transplantation evaluation without hesitation.
Abstract:
The outcome of patients with cystic fibrosis aged under 10 years referred for heart-lung transplantation assessment (n = 58) was determined and compared with older children (n = 109). Similar proportions were placed on to the active waiting list (64% v 71%) and received transplants (35% v 31%). Three year post-transplantation survival figures were also similar (41% v 46%), as were the figures for overall survival for those placed on to the active list (27% v 29%). Paediatricians should not be deterred from referring younger patients for transplantation.