Waitlist Outcomes in Pediatric Lung Transplantation: Poor Results for Children Listed in Adult Transplant Programs

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 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 transplant between 2002 and 2014; 720 (63.2%) of the candidates 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 ( 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 58% of the children and adolescents were listed in adult centers where the resultant transplant rate was low -- only 42% received a transplant compared to 93% in pediatric programs. Listing in an adult program was also the most significant risk factor for death on the waiting list (HR 15.6, CI 5.8-42.1). 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.