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Background: Lung transplantation in the pediatric population is a challenge. With the donor pool being so small and lungs from young donors rare and precious, every organ available needs to be utilized to its best potential., Case: Here, we describe the case of a 6-wk-old donor of double lungs to a 5-mo-old baby girl diagnosed with alveolar capillary dysplasia with misalignment of the pulmonary veins. The recipient is doing very well, 6 y after the transplant, now following normal growth., Discussion: The challenges facing pediatric cardiothoracic transplantation in terms of organ supply and demand are enormous., Conclusions: In this article, we discuss some of the issues around the shortage of organs and alternatives to increase the organ donor pool., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Sensitised patients undergoing Human Leukocyte Antigen-incompatible transplantation are at increased risk of hyperacute rejection and may be predisposed to antibody-mediated rejection, chronic lung allograft dysfunction and higher mortality., Case: We present a case of primary lung transplantation in the setting of late identification of donor specific antibodies treated with intraoperative target plasma exchange. The patient was treated with fresh human plasma to a final volume of 1.5 times the patient's systemic circulation. From a pre-transplant mean fluorescence intensity of 5002, donor-specific antibodies were undetectable following plasma exchange on single antigen bead assay., Conclusions: This method represents a potential desensitisation technique for use in the intraoperative period., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Pediatric LTX is challenged by the scarcity of suitable donor organs. To alleviate the problem of size matching, volume reduction of the donor is a possible option. Previous reports address mostly older teenagers, and data about younger patients are lacking. The purpose of this study was to investigate whether trimming had influence on the morbidity and mortality in slightly younger recipients, operated in a single center. Between 2015 and 2018, 20 patients were transplanted at the GOSH London. The mean age was 11.5 (±4.6) years. Nine patients underwent volume reduction prior to transplantation (T group). The other patients received classical bilateral LTX (NT group). Ischemia times were longer in the T group, but this difference was not statistically significant. We observed no 30-day mortality. Hospital survival in the T group was 78% vs 90% in the NT group. After almost 3 years, mortality in the T group was 22% vs 28% in the NT group. None of these differences was statistically significant. The mean duration of MV, intensive care stay, and hospital stay were 11.5, 19.9, and 44.8 days, respectively. Results were equal in terms of morbidity, defined as respiratory and neurological complications or the need for ECMO. Results show that volume reduction prior to LTX is a feasible option, even in smaller children. While awaiting long-term results, accepting larger donor organs could be a strategy to further reduce waiting list time and subsequently lower the mortality on the waiting list., (© 2020 Wiley Periodicals LLC.)

Background: Mycobacterium abscessus infection has been associated with variable outcomes following lung transplantation. M abscessus comprises three subspecies (M abscessus subsp abscessus, M abscessus subsp massiliense, and M abscessus subsp bolletii). We investigated whether lung transplantation outcome in cystic fibrosis (CF) patients in a single center was related to the M abscessus subspecies and genetic cluster., Methods: CF patients with chronic M abscessus infection transplanted at Great Ormond Street Hospital between 2004 and 2017 were retrospectively examined. All M abscessus isolates were identified to subspecies level by polymerase chain reaction and sequencing. Genetic cluster was determined by variable number tandem repeat profiling and whole-genome sequencing (WGS), and sequence type inferred from WGS., Results: Thirteen patients with chronic M abscessus infection underwent heart/lung or lung transplantation. Subspecies identification showed n = 1 with M abscessus bolletii, n = 5 with M abscessus massiliense, and n = 7 with M abscessus abscessus infection. Eight (62%) patients (one with M abscessus massiliense and seven with M abscessus abscessus) died post-lung transplant. The patient with M abscessus bolletii and three patients with M abscessus massiliense did well post-transplant. One patient with M abscessus massiliense is receiving ongoing treatment., Conclusions: Dramatically worse outcomes are observed in patients infected with M abscessus subspecies abscessus, the majority of whom were infected with ST-1 and ST-26 strains. Patients infected with other M abcsessus strains can have acceptable outcomes., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Pulmonary arterial hypertension after arterial switch operation for transposition of the great arteries is rare. Lung transplantation can be the last option in cases of failed medical therapy. We report 2 paediatric patients who underwent lung transplantation for this indication. Altered hilar anatomy, mediastinal adhesions and haemostatic control represent the main technical challenges. Volume-reduction surgery is sometimes necessary to address altered cardiopulmonary relationships while expanding the donor pool., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Purpose The mortality of pediatric patients awaiting lung transplantation is high, among other things because shortage of adequate sized donors. Herein we present our approach for critically ill patients awaiting urgent lung transplantation, in which we extend our donor size criteria and perform volume trimming of the donor lung. Methods A retrospective single center study was performed, reviewing all pediatric lung transplant patients. Between March 2015 and January 2018 twenty patients underwent bilateral lung transplantation. Demography was analysed. The end points include survival outcome and lung function tests following surgery. Results Mean age was 10.6 years (SD 4.6). and mean weight was 31.1kg (SD 14.6). Nine patients had cystic fibrosis, nine pulmonary arterial hypertension and 2 bronchiolitis obliterans. The majority was female (n=11 or 55%). In nine (45%) patients lung trimming (T group) was performed. Lobar venous blood gases taken during organ retrieval were used as guidance to determine which lobe was resected. Univariate analysis revealed no statistical significant difference in mortality between the trimming and the non-trimming group. Lung function tests between 6 and 12 months after transplantation revealed a median FEV of 90% (Min 42% Max 121%) in the non-trimming (NT) group versus 61% (Min 56% Max 97%) in the T group. The median FVC1 in the NT group was 94% (Min 40% Max 119%) versus 59% (Min 55% Max 116%) in the T group. The difference was not statistically significant. Conclusion In summary, lung transplant volume reduction surgery either by anatomical or non-anatomical resection is a procedure that could offer results comparable to the conventional lung transplantation without additional morbidity or mortality. This strategy extends the lung donor pool, especially for the critically ill pediatric patients. [ABSTRACT FROM AUTHOR]