Anna Katharina Zürn, Nicolaus Schwerk, Carsten Müller, Gregor Warnecke, Jawad Salman, Michael Sasse, Harald Köditz, Thomas Jack, Bettina Bohnhorst, Gesine Hansen, Oliver Keil, Katja Nickel, Dmitry Bobylev, Fabio Ius, Julia Carlens
Hannover Medical School. University Hospital of Schleswig-Holstein.
Germany
Journal of Heart and Lung Transplantation Open
JHLT Open 2025; 9:
DOI: 10.1016/j.jhlto.2025.100251
Abstract
Background: Infant lung transplantation (LuTx) has been rarely performed in Europe and poses unique challenges.
Methods: We reviewed referrals for LuTx to our center for patients below 1 year of age from January 1, 2018 to December 31, 2022. Clinical data and outcomes of transplanted infants and data on patients who were declined for evaluation, not listed after evaluation, or died before LuTx were collected. The number of donor lungs from organ donors younger than 1 year of age offered to our center and their utilization were analyzed for the same time period.
Results: A total of 18 referrals were analyzed. Ten referrals were declined; 2 had contraindications to transplant and 2 infants died after full evaluation. A total of 4 infants (median age 185 days, range 85-225; mean weight 6063 g, standard deviation [SD] ±438 g) underwent bilateral LuTx after a mean waiting time of 52, SD ±43 days. Underlying diseases included surfactant protein deficiencies (n = 3) and lung hypoplasia with pulmonary hypertension due to congenital diaphragmatic hernia (n = 1). Patients required oxygen supplementation (n = 1), noninvasive (n = 1), or invasive (n = 2) ventilation pre-LuTx. ABO blood group incompatible LuTx was performed in 2 patients. After a mean follow-up of 37, SD ±20 months, all patients are alive. Of 13 infant donor lungs offered to our center, 10 (76.9%) were declined due to the lack of a suitable recipient. Two of 3 infant donor lungs were transplanted to infants, 1 was transplanted to a 23-month-old recipient. The other 2 infants received lungs from donors aged over 12 months.
Conclusions: Our longitudinal analysis highlights the high pre-LuTx morbidity of infants with respiratory failure and challenges associated with timely evaluation and listing. Nevertheless, infant LuTx shows promising results in selected candidates, including ABO blood group incompatible transplantations.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Class III. Pulmonary Hypertension Associated with Developmental Diseases of the Lung
Lung Transplantation for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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Free PDF File or Full Text Article Available Through PubMed or DOI: Yes