Improved Outcomes for Infants and Young Children Undergoing Lung Transplantation at Three Years of Age and Younger

Melicoff, Ernestina; Spielberg, D.R.; Heinle, Jeffrey S.; McKenzie, E. Dean; Hosek, K; Schrader, Anna L; Mallory, George B.

doi:10.1513/annalsats.202202-093oc

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…Recent studies suggest that lung transplant in older children and adults with severe BPD is feasible and has comparable outcomes to patients with other lung diseases 27–29 . Infant lung transplantation, including recipients with grade 3 BPD, has shown encouraging outcomes 30,31 . In our cohort, the children had variable neurodevelopmental delays, with one having autism.…”

Section: Discussionmentioning

confidence: 72%

“…[27][28][29] Infant lung transplantation, including recipients with grade 3 BPD, has shown encouraging outcomes. 30,31 In our cohort, the children had variable neurodevelopmental delays, with one having autism.…”

Section: Resultsmentioning

confidence: 97%

“…These outcomes are all well described in survivors of prematurity with or without lung disease. Melicoff identified that neurodevelopmental delays following lung transplant in severe BPD are common but clinically manageable by their caregivers, parents, and primary physicians 31 . Lung transplantation in infants with end‐stage BPD and pulmonary hypertension should be considered in selected cases as a possible life‐saving intervention.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Maynard,

Armstrong,

O'Grady

et al. 2024

Pediatric Pulmonology

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BackgroundPremature infants surviving beyond a postmenstrual age (PMA) of 36 weeks with severe or grade 3 bronchopulmonary dysplasia (sBPD) have significant predischarge mortality. The in‐hospital mortality for BPD supported by invasive mechanical ventilation beyond 36 weeks PMA is not well described. The role of lung transplantation in treating severe BPD is uncertain. We studied our experience over 20 years to better define the predischarge mortality of infants with progressive grade 3 BPD and whether lung transplant is a feasible intervention.MethodsData were obtained from a retrospective review of medical records from Children's Minnesota over a 20‐year period (1997–2016). Inclusion criteria included prematurity <32 weeks PMA, BPD, tracheostomy for chronic respiratory failure, and survival beyond 36 weeks PMA. Collected data included perinatal demographics, in‐hospital medications and interventions, level of respiratory support, and outcomes.ResultsIn all, 2374 infants were identified who survived beyond 36 weeks PMA with a diagnosis of <32 weeks gestation prematurity and BPD. Of these, 143/2374 (6.0%) survived beyond 36 weeks PMA and required invasive mechanical ventilation with subsequent tracheostomy for management. Among these patients, discharge to home with tracheostomy occurred in 127/143 (88.8%), and predischarge death or lung transplantation occurred in 16/143 (11.2%). Deteriorating cardiopulmonary status was associated with pulmonary hypertension, prolonged hypoxemic episodes and the need for deep sedation or neuromuscular relaxation. Three of four patients referred for lung transplantation had >5‐year survival, chronic allograft rejection, and mild to moderate developmental delays.ConclusionsChronic respiratory failure requiring invasive mechanical ventilation for grade 3 BPD is associated with significant morbidity and mortality. For selected patients and their families, timely referral for lung transplantation is a viable option for end‐stage grade 3 BPD. As in other infants receiving solid organ transplants, long‐term issues with co‐morbidities and special needs persist into childhood.

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Section: Discussionmentioning

confidence: 72%

Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Maynard,

Armstrong,

O'Grady

et al. 2024

Pediatric Pulmonology

Self Cite

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Interstitial lung disease as an indication for pediatric lung transplant

Kuklinski,

Blatter

2023

Pediatric Pulmonology

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Interstitial lung disease can be an indication for lung transplant at any age, but it is a particularly common indication for lung transplant in infants. Nevertheless, not all interstitial lung diseases will lead to lung transplant in childhood. Genetic testing has aided the identification of these diseases in children. In severely affected patients, however, definitive diagnosis is not always necessary to consider referral to a transplant center. At experienced transplant centers, a multidisciplinary team educates patient families and aids in the transplant evaluation of children with interstitial lung disease. Children who have undergone transplant require lifetime immunosuppression and close surveillance, but can enjoy good quality of life for years following surgery.

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Differential donor management of pediatric vs adult organ donors and potential impact on pediatric lung transplantation

Spielberg

Melicoff²,

Heinle³

et al. 2023

The Journal of Heart and Lung Transplantation

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Improved Outcomes for Infants and Young Children Undergoing Lung Transplantation at Three Years of Age and Younger

Cited by 3 publications

References 23 publications

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Interstitial lung disease as an indication for pediatric lung transplant

Differential donor management of pediatric vs adult organ donors and potential impact on pediatric lung transplantation

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