Waiting list outcomes in pediatric lung transplantation: Poor results for children listed in adult transplant programs

Brandi B. Scully, Matthew Goss, Hao Liu, Michael L. Keuht, Iki Adachi, E. Dean McKenzie, Charles D. Fraser, Ernestina Melicoff, George B. Mallory, Jeffery S. Heinle, Abbas Rana

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background Low case volume has been associated with lower survival after pediatric lung transplantation. Our aim was to analyze waitlist outcomes among pediatric lung transplant centers in the USA. Methods We studied a cohort of 1,139 pediatric candidates listed in the Organ Procurement and Transplantation Network for lung transplantation between 2002 and 2014. Of these candidates, 720 (63.2%) received a transplant. Candidates were divided into groups according to the clinical activity of the center of listing: high-volume pediatric (≥4 transplants per year); low-volume pediatric (<4 transplants per year); and adult (transplant volume predominantly in adults). We used multivariate Cox regression analysis to identify independent risk factors for waitlist mortality. We also determined the transplant rate—or likelihood of transplant after listing—over the study period. Results Fifty-eight percent of the children and adolescents were listed in adult centers where the resultant transplant rate was low—only 42% received a transplant compared with 93% in pediatric programs. Listing in an adult program was also the most significant risk factor for death on the waiting list (hazard ratio 15.6, 95% confidence interval 5.8 to 42.1). Conclusions Most children (58%) are listed for lung transplantation in adult centers and have a reduced rate of transplantation and a greater chance of waitlist mortality.

Original languageEnglish (US)
Pages (from-to)1201-1208
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume36
Issue number11
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

Keywords

  • case volume
  • lung transplantation
  • outcomes
  • pediatric lung transplant
  • pediatric transplantation
  • thoracic surgery
  • transplant rate
  • waitlist survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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