Zürn Anna Katharina, Schwerk Nicolaus, Müller Carsten, Warnecke Gregor, Salman Jawad, Sasse Michael, Köditz Harald, Jack Thomas, Bohnhorst Bettina, Hansen Gesine, Keil Oliver, Nickel Katja, Bobylev Dmitry, Ius Fabio, Carlens Julia
Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany.
Department of Cardiac Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
JHLT Open. 2025 Mar 31;9:100251. doi: 10.1016/j.jhlto.2025.100251. eCollection 2025 Aug.
Infant lung transplantation (LuTx) has been rarely performed in Europe and poses unique challenges.
We reviewed referrals for LuTx to our center for patients below 1 year of age from January 1, 2018 to December 31, 2022. Clinical data and outcomes of transplanted infants and data on patients who were declined for evaluation, not listed after evaluation, or died before LuTx were collected. The number of donor lungs from organ donors younger than 1 year of age offered to our center and their utilization were analyzed for the same time period.
A total of 18 referrals were analyzed. Ten referrals were declined; 2 had contraindications to transplant and 2 infants died after full evaluation. A total of 4 infants (median age 185 days, range 85-225; mean weight 6063 g, standard deviation [SD] ±438 g) underwent bilateral LuTx after a mean waiting time of 52, SD ±43 days. Underlying diseases included surfactant protein deficiencies ( = 3) and lung hypoplasia with pulmonary hypertension due to congenital diaphragmatic hernia ( = 1). Patients required oxygen supplementation ( = 1), noninvasive ( = 1), or invasive ( = 2) ventilation pre-LuTx. ABO blood group incompatible LuTx was performed in 2 patients. After a mean follow-up of 37, SD ±20 months, all patients are alive. Of 13 infant donor lungs offered to our center, 10 (76.9%) were declined due to the lack of a suitable recipient. Two of 3 infant donor lungs were transplanted to infants, 1 was transplanted to a 23-month-old recipient. The other 2 infants received lungs from donors aged over 12 months.
Our longitudinal analysis highlights the high pre-LuTx morbidity of infants with respiratory failure and challenges associated with timely evaluation and listing. Nevertheless, infant LuTx shows promising results in selected candidates, including ABO blood group incompatible transplantations.
婴儿肺移植（LuTx）在欧洲很少进行，且带来独特挑战。
我们回顾了2018年1月1日至2022年12月31日期间转诊至我们中心的1岁以下婴儿的肺移植情况。收集了移植婴儿的临床数据和结果，以及被拒绝评估、评估后未列入名单或在肺移植前死亡的患者的数据。同时分析了提供给我们中心的1岁以下器官捐献者的供体肺数量及其利用情况。
共分析了18例转诊病例。10例转诊被拒绝；2例有移植禁忌证，2例婴儿在全面评估后死亡。共有4例婴儿（中位年龄185天，范围85 - 225天；平均体重6063克，标准差[SD]±438克）在平均等待52天（SD±43天）后接受了双侧肺移植。基础疾病包括表面活性物质蛋白缺乏症（n = 3）和先天性膈疝导致的肺发育不全伴肺动脉高压（n = 1）。肺移植前，患者需要吸氧（n = 1）、无创通气（n = 1）或有创通气（n = 2）。2例患者进行了ABO血型不相容的肺移植。平均随访37个月（SD±20个月）后，所有患者均存活。提供给我们中心的13个婴儿供体肺中，10个（76.9%）因缺乏合适受体而被拒绝。3个婴儿供体肺中有2个移植给了婴儿，1个移植给了一名23个月大的受者。另外2例婴儿接受了12个月以上供体的肺。
我们的纵向分析突出了呼吸衰竭婴儿肺移植前的高发病率以及与及时评估和列入名单相关的挑战。尽管如此，婴儿肺移植在选定的候选者中显示出有希望的结果，包括ABO血型不相容的移植。
