Pediatric Heart-Lung Transplantation Through the Decades: A Single-Center Analysis

Abstract

<h3>Purpose</h3> Pediatric heart-lung transplantation is an uncommon surgical approach utilized in children with end-stage cardiopulmonary failure. We sought to provide a detailed report of our experience at a high-volume institution over three decades. <h3>Methods</h3> We analyzed all pediatric heart-lung transplantations performed between 1993 and 2020. Medical records were reviewed for transplant indications, preoperative risk factors, postoperative complications, and survival outcomes. Patients were stratified and compared by surgical decade: 1993-2000, 2001-2010, and 2011-2020. Data are expressed as median (IQR) or percent. <h3>Results</h3> Twenty-two children were included in this study. One patient from the 1st decade with prior tetralogy of Fallot repair and aortic valve replacement experienced massive hemorrhage following sternotomy and passed away before the transplant could be performed. Median age at transplant was 13.8 (9.9-16.3) years. 2 (9.1%) children were supported on extracorporeal membrane oxygenation (ECMO) pre-transplant. 17 (77.3%) had congenital heart disease, including two with single-ventricle physiology. Median postoperative length of stay was 17 (10-51) days. All 5/22(23%) children on ECMO post-transplant died before discharge. Median follow-up for hospital survivors was 5.0 (2.9-7.9) years. Patients transplanted from 2010-2020 had the highest survival rate (Table). Transplant-free survival at 1, 3, and 5 years was 72.7%, 63%, and 52%, respectively. 3/11(14%) underwent redo bilateral lung transplantation due to severe bronchiolitis obliterans (BOS), with 2 alive at last follow-up. Children transplanted in the most recent decade had significantly lower rates of BOS. <h3>Conclusion</h3> The spectrum of children undergoing heart-lung transplant has changed over time, although postoperative ECMO remains an important risk factor for mortality. While survival after discharge appears promising in the most recent decade, discussions regarding long-term survival are warranted prior to listing.