Improved Outcomes of Infant Lung Transplantation Over 3 Decades

Horacio G. Carvajal, Taylor C. Merritt, Matthew W. Canter, Aaron M. Abarbanell, Dilip S. Nath, Pirooz Eghtesady

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Lung transplantation is the definitive surgical treatment for end-stage lung disease. However, infants comprise less than 5% of pediatric cases. This study sought to provide an overview of infant lung transplantation outcomes over the past 3 decades by using linked United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) data. Methods: Infants undergoing lung transplantation from 1989 to 2020 in UNOS were reviewed. UNOS and PHIS records for patients who underwent lung transplantation from 1995 to 2020 were linked using date of birth, sex, and date of surgery ± 3 days. The study assessed underlying diagnoses, pretransplant and posttransplant extracorporeal membrane oxygenation support, retransplant-free survival to discharge, hospital experience (≥1 annual transplant for ≥4 years in a 5-year period), operative decade, bronchiolitis obliterans syndrome, long-term survival, and functional status at latest follow-up. Results: A total of 112 lung transplants were performed in 109 infants over 31 years. Of these, 21 patients died before discharge, and 2 underwent repeat transplantation during the same admission. The study linked 80.6% (83 of 103) of UNOS and PHIS records. Hospital survival was lower for infants with idiopathic pulmonary hypertension and those who underwent transplant procedures at less experienced centers. All 7 infants requiring postoperative extracorporeal membrane oxygenation support died. Median freedom from bronchiolitis obliterans syndrome was 8.1 years (interquartile range, 4.6 to 11.6 years). After discharge, median survival was 10.3 years (interquartile range, 6.3 to 14.4 years), with improved 10-year survival for those patients who underwent transplantation from 2010 to 2020 (87.3%) vs 2000 to 2009 (52.4%; P =.098) and 1989 to 1999 (34.1%; P =.004). A total of 84.6% (33 of 39) of survivors had minor or no restrictions at latest follow-up. Conclusions: Carefully selected infants experience promising short- and long-term outcomes after lung transplantation.

Original languageEnglish (US)
Pages (from-to)184-192
Number of pages9
JournalAnnals of Thoracic Surgery
Issue number1
StatePublished - Jul 2022

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery


Dive into the research topics of 'Improved Outcomes of Infant Lung Transplantation Over 3 Decades'. Together they form a unique fingerprint.

Cite this