Lung transplantation is an established therapy option for children and young people with serious and progressive lung diseases without any other alternative treatment. However, experiences have been very sparse due to the low number of patients worldwide compared to adults.
Cystic fibrosis (CF) is today still the most frequent indication for lung transplantation in children and adolescents, although the proportion has in the past few years continued to decline due to increasingly improved treatment possibilities. Whereas the number of transplantations in critically ill young children with other underlying diseases such as pulmonary hypertension (PH) or childhood interstitial lung disease (ChILD) has steadily risen. With this shift there is a simultaneous decrease in age at the time of transplantation from adolescence towards children, infants and down to babies. „The ‚new‘ indications and young age present the attending doctors with new challenges“, says PD Dr. Nicolaus Schwerk, researcher at the German Center for Lung Research (DZL) and senior physician at the Clinic for Pediatric Pneumology, Allergology and Neonatology at Hannover Medical School. Here there are, for example, prior to transplantation seriously ill children, sometimes needing ventilation, and with heterogeneous and complex diseases additionally involving other organ systems. „A further important point is the increased vulnerability of the child’s body to potentially toxic medication as well as radiation exposure from diagnostic procedures“, Schwerk emphasizes.
In a retrospective study, Nicolaus Schwerk and other DZL scientists have now examined the clinical status prior to transplantation as well as the post-operative development of children under 12 years of age for a period of 16 years and compared this with the results of adolescents over 12 years. Of the 1766 patients (male and female), who received transplants from 2005-2021 at Hannover Medical School, 126 were under 18 years. Of these, 42 children under 12 and 75 adolescents over 12 years were taken into consideration. In the group of children, the indications ChILD and PH were represented significantly more frequently than in the group of adolescents, where CF was the most frequent indication. Children had to be significantly more frequently mechanically ventilated than the adolescents, and they also more frequently required mechanical lung or heart and lung support both during and after transplantation. In addition, children had to be ventilated and receive intensive care for a significantly longer period than adolescents. Organ survival 1, 5 and 8 years after transplantation in both children and adolescents was 91%, 72% and 68% and in the group of children with 90%, 80% and 80% was generally speaking, but statistically not significantly better than in the group of adolescents (92%, 69% and 62%). Eight years after transplantation, 87% of the children and 69% of the adolescents were still alive. There were no differences with regard to acute and chronic rejections as well as infections requiring hospital treatment.
To sum up, it could be shown that children at the time of transplantation are in a more critical condition than adolescents. Nevertheless, the long-term course in this age group is actually tendentially better than in adolescents, which is why this therapy option should be taken into consideration more often.
Indications and outcome after lung transplantation in children under 12 years of age: A 16-year single center experience
P. Iablonskii et al; J Heart Lung Transplant. 2022 Feb;41(2):226-236.
doi: 10.1016/j.healun.2021.10.012. Epub 2021 Oct 28. PMID: 34836753.
Text: N. Schwerk
Photo: MHH / T. Figiel