Turner Darren, Morales David L, Hayes Don
The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
JHLT Open. 2025 Jul 25;10:100355. doi: 10.1016/j.jhlto.2025.100355. eCollection 2025 Nov.
Lung transplantation remains the optimal treatment for children with end-stage lung disease, yet donor organ shortage represents the greatest obstacle to transplantation. In 2023, only 31 pediatric lung transplants were performed in the United States, with 9% of recovered lungs ultimately not transplanted. Pediatric waitlist mortality has increased, particularly for patients under one year of age, necessitating innovative strategies to expand the donor pool.
This review examines emerging strategies to combat organ shortage in pediatric lung transplantation, including extended criteria donors, deceased cardiac death (DCD) organ donation, ex-vivo lung perfusion (EVLP), graft size reduction techniques, living donor lobar transplantation, and utilization of hepatitis C and HIV-positive donor organs. We analyzed current literature and clinical outcomes data to assess the feasibility and safety of these approaches in pediatric populations.
Extended criteria donors now account for 80% of lung transplants without compromising short- and mid-term pediatric outcomes. DCD lung transplantation demonstrates comparable survival rates to brain-dead donors, with only 14 DCD organs used in pediatric programs between 2004-2022. EVLP shows promise in preserving organ viability and reducing primary graft dysfunction. Hepatitis C-positive donors demonstrate excellent outcomes with direct-acting antiviral therapy in adult patients, but scant literature is available in the pediatric population. Reduced-size grafts and living donor procedures offer solutions for size-mismatched recipients.
Multiple innovative strategies show potential for expanding the pediatric lung donor pool. While adult data demonstrates safety and efficacy, pediatric-specific research remains limited. Continued scientific inquiry, active donor management protocols, and interdisciplinary cooperation are essential to safely implement these approaches and improve access to life-saving transplantation for children.
肺移植仍然是终末期肺病患儿的最佳治疗方法，但供体器官短缺是移植的最大障碍。2023年，美国仅进行了31例小儿肺移植，回收的肺中有9%最终未进行移植。小儿等待名单上的死亡率有所上升，尤其是一岁以下的患者，因此需要创新策略来扩大供体库。
本综述探讨了应对小儿肺移植器官短缺的新兴策略，包括扩大标准供体、心脏死亡后器官捐献（DCD）、体外肺灌注（EVLP）、移植物减容技术、活体供体肺叶移植以及利用丙型肝炎和HIV阳性供体器官。我们分析了当前的文献和临床结果数据，以评估这些方法在小儿人群中的可行性和安全性。
扩大标准供体目前占肺移植的80%，且不影响小儿的短期和中期预后。DCD肺移植的生存率与脑死亡供体相当，2004年至2022年间小儿项目中仅使用了14个DCD器官。EVLP在保存器官活力和减少原发性移植物功能障碍方面显示出前景。丙型肝炎阳性供体在成年患者中通过直接抗病毒治疗显示出良好的结果，但小儿人群中的相关文献很少。减容移植物和活体供体手术为大小不匹配的受者提供了解决方案。
多种创新策略显示出扩大小儿肺供体库的潜力。虽然成人数据表明了安全性和有效性，但小儿特异性研究仍然有限。持续的科学探究、积极的供体管理方案以及跨学科合作对于安全实施这些方法和改善儿童获得挽救生命的移植机会至关重要。
