Shorter waiting times and longer survival in infants undergoing lung transplantation

important point

• Younger patients had shorter waiting times for lung transplantation compared with patients aged 3 years and older.
• Children under 3 years of age who received transplants had more morbidity.

A study published in , shows that children under 3 years of age undergoing lung transplantation have different diagnoses, shorter waiting times, and long-term survival rates similar to older patients. Chronicles of the American Thoracic Society.

“Carefully selected infants and young children with end-stage pulmonary and pulmonary vascular disease are good candidates for lung transplantation and may fall short of current clinical practice.” Ernestina Melikov, medical doctor, He is an assistant professor in the Department of Pediatric Respiratory Medicine at Baylor College of Medicine and the medical director of the Texas Children’s Hospital Lung Transplant Program, writes a colleague.

In a retrospective review, Melicoff et al. analyzed 36 infants/children under 3 years of age who underwent lung transplantation at Texas Children’s Hospital between 2002 and 2020, and compared the diagnosis, waiting time, and severity of disease in patients in this age group. , and mortality were addressed. Researchers say this age group rarely receives transplants worldwide.

The researchers compared these patients with 192 children aged 3 and older who had transplants at Texas Children’s Hospital during the same period. Elderly transplant recipients from this program were also included for comparison.

Of the cohort of patients <3 years of age, 4 patients were 2-3 years of age, 10 were 1-2 years of age, and 22 were <1 year of age at the time of lung transplantation.

Diagnosis, referrals, waiting times

Compared to the older cohort, the researchers found that the younger cohort had different inherent underlying conditions. According to researchers, 15 of her children under the age of 3 have surfactant dysfunction disorder, a rare diagnosis in older patients. Other diagnoses in this cohort included bronchopulmonary dysplasia (n = 5), FLNA (Filamin A) mutations with progressive respiratory failure (n = 6), primary pulmonary vascular disease (n = 4) and other disorders (n = 6).

Additionally, none of the children in the younger cohort had cystic fibrosisa regularly reported diagnosis in older patients, the researchers note.

Looking at referrals, patients younger than 3 years were referred compared to the older cohort (30% vs 70%) and fewer were listed for transplantation (17.2% vs 38.8%).

In terms of waiting time, researchers found that patients younger than 3 years waited less than older patients (median ± standard deviation, 32 days ± 26.3 vs. 66 days ± 105.8; P. < .0043). The researchers also noted that the latency found in the younger cohort was lower than the national average.

Accounting for ages <1 to 18+, the median wait time for <1 year was the shortest at 26 days, followed by 1 to 3 years (35.5 days) and 12 to 17 years. 1 year (42 days), 18+ (54 days), 3-12 years (78 days).

Morbidity, Mortality

When evaluating anesthesia and surgical approaches performed in younger and older recipients, the researchers said there was no difference. This is because the Texas Children’s Hospital program does not use the test when testing her patients under the age of five.

Compared with an older cohort, the researchers found that patients younger than 3 years of age received transplants and were admitted to the ICU (12 patients vs. 32 patients) and used tracheostomy tubes (5 patients vs. 32 patients). 24) were using tracheostomy tubes. extracorporeal membrane oxygenation Pre-transplantation (2 patients vs. 5 patients) indicates high morbidity.

Within a year after transplant, researchers observed a low incidence of allograft rejection, with only two patients in the younger cohort requiring treatment.

In terms of post-transplant mortality, researchers observed comparable survival rates at 1 year between cohorts under 3 years of age and older cohorts (87.9% vs. 89.6%).

Additionally, the researchers wrote, five-year survival rates were similar for the under-3 age group and the overall program age group. Importantly, younger patients show ‘durable survival’ over the ensuing years compared to the overall cohort with stable mortality.

Researchers found that infant recipients had a higher early survival rate between 2011 and 2019 than between 2002 and 2010 when looking at the timing of the transplant.

After transplantation, 13 children (39%) under the age of 3 years died, mainly due to bronchiolitis obliterans (n ​​= 5) and viral pneumonia (n = 5). The remaining causes each occurred in one of her children: status epilepticus, multiple organ failure, premature death from primary graft dysfunction. Most of these deaths occurred within 3 months (n = 4) or 2 years (n = 4) after transplantation.

“We believe that the practicality and availability of lung transplantation for infants and young children is underappreciated and accepted within the neonatology, pediatric critical care, and even pediatric respiratory communities. We think,” wrote Melicoff and colleagues. “We hope that this manuscript will address this inadequacy. Our experience shows that these patients can be managed pre- and post-transplant, have very short waiting times, and not necessarily high mortality during the waiting period.” instead, survival and long-term outcomes have improved over time.”