Surgical Considerations in Infant Lung Transplantation

Challenges and Opportunities

John P. Costello; Horacio G. Carvajal; Aaron M. Abarbanell; Pirooz Eghtesady; Dilip S. Nath


American Journal of Transplantation. 2021;21(1):15-20. 

In This Article

Future Directions

Despite the low number of procedures performed annually, lung transplantation has proven to be an effective treatment for end-stage pulmonary failure in infants. Postoperative results in this age group show that infants experience lower rates of acute rejection and similar long-term survival when compared to older children. One of the major obstacles to the widespread adoption of this approach is the lack of suitable donors and resulting variable waitlist times. Advances in bridging technology, such as PLAD, address these limitations by allowing for prolonged support in a manner compatible with physical rehabilitation and decreased need for sedation and narcotics. As this technology becomes more widespread, we expect an increase in the number of infants who survive to lung transplantation.

Currently, the most common reported approach to lung transplant in infants is the bilateral sequential technique. Single-institution reports in both children and adults suggest that en bloc lung transplantation with BAR may result in improved survival, fewer ischemic complications, and lower rates of bronchiolitis obliterans. Data in infants, however, remain limited, and a prospective study focused specifically on infants is needed to assess the results of different surgical techniques. Overall, the unique characteristics of lung transplantation in infants are accompanied by interesting challenges and opportunities. As the field continues to evolve in response to new studies and technological advances, more infants will be able to benefit from lung transplantation.