Pediatric Multiorgan Lung Transplantation: Four Decades of National Trends and Outcomes.

Abstract

Background: Pediatric lung transplantation (LTx) and multiorgan lung transplantation (MOLT) remain uncommon, and national data describing temporal trends and outcomes are limited. We characterized four decades of MOLT in the United States, with particular emphasis on the evolving pediatric experience.

Methods: We analyzed Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files provided by the United Network for Organ Sharing from 1987 to 2024. The cohort included 54 797 isolated LTx recipients and 1 963 MOLT recipients, classified into mutually exclusive groups of dual-organ lung-heart (n = 1557), lung-liver (n = 216), lung-kidney (n = 154), and other multiorgan configurations (n = 36). Cox regression, Fine-Gray competing-risks, landmark, and interaction analyses evaluated graft-failure associations across four transplant eras and seven age groups.

Results: Pediatric transplant volume declined substantially, comprising 0.8% of isolated LTx procedures in 2020-2024. Lung-heart transplantation decreased from 9.0% of lung-involved procedures before 2000 to 1.8% in 2020-2024, whereas lung-liver and lung-kidney transplantation increased modestly, predominantly among adults. Pretransplant ECMO use increased across cohorts, reaching 27.6% among lung-heart and 27.8% among lung-kidney recipients in 2020-2024. One-year graft survival improved progressively across eras.

Conclusions: Pediatric MOLT has evolved within a changing national lung-transplant landscape characterized by declining pediatric volume, shifting procedural patterns, increasing recipient acuity, and improving early graft outcomes. Continued evaluation is needed as long-term follow-up from recent eras matures.