Extended criteria lungs for transplantation in children?
A retrospective analysis of all pediatric lung transplants performed in Hannover over a recent six-year period suggests that extended criteria lungs can be used safely for pediatric lung transplantation without compromising short- and mid-term results.
The group from Hannover(3) compared results of 27 transplants performed with standard criteria (SC) lungs versus 30 with extended criteria (EC) lungs. Pre-operative recipient characteristics, such as age, underlying disease, ICU admission, ventilatory support and ECMO, were similar in both groups.
Although the EC group underwent more atypical volume reductions of the allograft, and they also spent less time on mechanical ventilation, there were no differences between the EC and SC groups in ECMO support, total ICU stay, or total hospital stay. There were also no significant differences in chronic allograft dysfunction one and five years after surgery or in survival rates up to five years. In fact, rather surprisingly, there was a marked trend to better long-term survival at five years (68% vs 90%) in the EC group.
These reassuring pediatric results seem to mirror similar findings in adults from the same authors in 2013(4) in which EC lungs (previously rejected at least three times) were transplanted into stable recipients with very good long-term survival.
And infants …
Also, on the topic of pediatric transplantation, a remarkable case report concerning successful lung donation at the age of six weeks was recently published (5). The case report (from Royal Papworth Hospital and Gt Ormond Street Hospital in the UK) describes a challenging transplantation of bilateral lungs from a six-week old infant with sepsis secondary to bacterial meningitis; the recipient was a four-month-old child with alveolar capillary dysplasia and misaligned pulmonary veins. Implantation of the lungs was performed via bilateral thoracosternotomy on cardiopulmonary bypass, cooling to 30°C. Two years later, the recipient is doing well with normal lung function.
3. Sommer W et al, Extended criteria donor lungs do not impact recipient outcomes in paediatric transplantation. J Heart Lung Transplant. 2019 May;38(5):560-569. doi: 10.1016/j.healun.2019.02.012. Epub 2019 Feb 27. (link to abstract)
4. Sommer W et al, Extended criteria donor lungs and clinical outcome: results of an alternative allocation algorithm. J Heart Lung Transplant. 2013 Nov;32(11):1065-72. doi: 10.1016/j.healun.2013.06.021. Epub 2013 Aug 13. (link to abstract)
5. Pavlushkov E et al, Successful lung donation at the age of 6 weeks: Challenges and lessons learned. Pediatr Transplant. 2019 Apr 23:e13419. doi: 10.1111/petr.13419. Epub ahead of print. (link to abstract)
Xvivo Insights PB-2019-06-27