Paval Iablonskii, Julia Carlens, Carsten Mueller, Khalil Aburahma, Adelheid Niehaus, Dietmar Boethig, Maximilian Boethig, Katharina Floethmann, Wiebke Sommer, Joerg Optenhoefel, Igor Tudorache, Mark Greer, Harald Koeditz, Thomas Jack, Georg Hansmann, Christian Kuehn, Alexander Horke, Gesine Hansen, Axel Haverich, Gregor Warnecke, Murat Avsar, Jawad Salman, Dmitry Bobylev, Fabio Ius, Nicolaus Schwerk
Hannover Medical School. Saint Petersburg State University. Heidelberg Medical School. University Hospital Düsseldorf.
Germany and Russia
Journal of Heart and Lung Transplantation
J Heart Lung Transplant 2022; 41: 226-236
DOI: 10.1016/j.healun.2021.10.012
Abstract
Objective: Paediatric lung transplantation poses unique management challenges. Experience regarding indications and outcome is scarce, especially in younger children. The primary aim of this study was to investigate outcome after first lung transplantation in children <12 years of age in comparison to adolescents (12-17 years old).
Methods: Records of patients <18 years who underwent first lung transplantation between 01/2005 and 01/2021 were retrospectively reviewed, and compared between children <12 years old and adolescents. Median (IQR) follow-up was 51 (23-91) months.
Results: Of the 117 patients underwent first lung transplantation at our institution, of whom 42 (35.8%) patients were <12 years and 75 (64.2%) ≥12 years old. Compared to adolescents, children were more often transplanted for interstitial lung disease (33.3% vs 12%, p = 0.005) and precapillary pulmonary hypertension (28.6% vs 12%, p = 0.025), and required more often intraoperative cardiopulmonary bypass (31% vs 14.7%, p = 0.036) and postoperative ECMO support (47.6% vs 13.3%, p < 0.001). Postoperatively, children required longer ventilation times (78 vs 18 hours, p = 0.009) and longer ICU stay (9.5 vs 3 days, p < 0.001) compared to their older counterparts. Primary graft dysfunction grade 3 at 72 hours (9.5% vs 9.3%, p = 0.999), in-hospital mortality (2.4% vs 6.7%, p = 0.418), graft survival (80% vs 62%, p = 0.479) and freedom from chronic lung allograft dysfunction (76% vs 59%, p = 0.41) at 8-year follow-up did not differ between groups.
Conclusions: Lung transplantation in children under 12 years is challenging due to underlying medical conditions and operative complexity. Nevertheless, outcomes are comparable to those in older children.
Category
Lung Transplantation for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
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