Impact on post-transplantation outcomes in pediatric patients undergoing heart–lung transplantation by recipient age at the time of transplantation

Objective: The impact of age at transplantation on the outcomes of pediatric heart–lung transplantation (HLTX) recipients is not well described. Methods: The UNOS database (1987–2023) was retrospectively queried for primary pediatric HLTX in patients ≤18 year of age. The cohort was dichotomized into ages <12 years (Young group [YG]) and ≥12 years (Old group [OG]) due to its impact on the previously used lung allocation score (LAS). The data were extracted for clinic characteristics and outcomes. Standard statistical tests were used. Results: 217 (113 YG, 104 OG) patients underwent HTLX. The median age of YG was 4 years, compared to 15 years in OG ( P < 0.001). There was no difference in gender, ethnicity, lung diagnosis, cardiac diagnosis, or blood group. The OG had a higher LAS score but a lower heart listing status. The use of life support (mechanical ventilation, dialysis, and inotrope use) and extracorporeal membrane oxygenation (ECMO) pretransplant was no different. There was a higher donor/recipient height mismatch in the YG. The HTLX rate has fallen over the decades, especially among the YG. The ischemic times were similar. Posttransplant, prolonged mechanical ventilation was higher in YG, but with lower airway dehiscence, and dialysis, stroke, and rejection incidence were similar in the groups. The 1-year and long-term survival to 17 years was inferior in the YG. On multivariable analysis, only YG and ECMO bridge predicted 1-year mortality. Conclusion: There is a declining trend in HLTX in pediatric patients, with fewer YG patients. The long-term survival of YG was inferior. Recipient age and ECMO bridge were the only independent predictors of mortality.