A "Lung Transplant" Rebirth: A Five-Year Review and Outlook on Pediatric Lung Transplantation in China

Introduction: When Breathing Becomes a Luxury

For many children suffering from end-stage lung disease, every breath is a difficult battle. When medication and conventional treatments are no longer effective, lung transplantation becomes their last hope for a new life. However, pediatric lung transplantation is an extremely challenging medical problem globally due to its high technical difficulty, scarcity of donors, and complex post-operative management. Recently, a study published in the "World Journal of Pediatrics" systematically reviewed the current status of pediatric lung transplantation in China between 2019 and 2023, revealing the latest progress and valuable experience in this field.

Background: China's Pediatric Lung Transplantation Progressing Through Exploration

Lung transplantation is an effective treatment for various end-stage lung diseases, significantly extending patients' lives and improving their quality of life. Although adult lung transplantation technology has become increasingly mature in China, the development of pediatric lung transplantation has lagged behind. This is due to multiple factors: the extremely limited availability of suitable pediatric donor lungs, the difficulty in matching body sizes between affected children and donors, and the complex immunosuppression and infection control required after surgery, all of which make pediatric lung transplantation the "jewel in the crown of transplantation." In this context, a comprehensive understanding of the clinical characteristics, surgical indications, and post-operative survival of pediatric lung transplantation in China is crucial for promoting the development of this field. This study, based on data from the China Lung Transplant Registry (CLuTR), retrospectively analyzed 62 pediatric lung transplant surgeries (involving 62 children) performed in 13 hospitals nationwide over the past five years.

Key Findings: Challenges and Hope Coexist

The study revealed several core findings:

1. Steady Growth Trend: Between 2019 and 2023, a total of 63 pediatric lung transplant surgeries were completed in China, with the annual number of surgeries increasing from 9 in 2019 to 22 in 2023, indicating that this field is in a period of gradual development and growth. Although the total number of surgeries only accounted for 1.8% of the national total lung transplants, this growth trend is undoubtedly a positive sign.
2. Main Causes: The primary disease leading to the need for lung transplantation in children was "bronchiolitis obliterans syndrome" (BOS), accounting for 46% of all cases. This is a severe complication that occurs after transplantation or due to certain diseases, leading to small airway obstruction and destruction. This was followed by cystic fibrosis (12.7%) and idiopathic pulmonary hypertension (11.1%).
3. Post-operative Challenges: Infection was the most common post-operative complication, with an incidence rate as high as 63.9%. In addition, the study also observed that the incidence of acute rejection was higher in transplant centers with less surgical experience; while in experienced, high-volume centers, the risk of infection and primary graft dysfunction was relatively higher. This suggests that centers with different levels of experience face different challenges.
4. Encouraging Survival Rates: The most exciting finding of the study was the excellent post-operative survival rate of pediatric lung transplantation in China. The 30-day survival rate was 93.5%, and the one-year survival rate was as high as 80.6%. More notably, this one-year survival rate was significantly higher than that of adult patients who underwent double-lung transplantation during the same period (adults were 58.7%). This indicates that despite numerous challenges, pediatric patients have better recovery potential and survival prospects after transplantation.

Introduction to Research Methods

The research team collected all data on lung transplants performed for children aged 17 and under in 13 qualified hospitals nationwide from January 2019 to December 2023 through the China Lung Transplant Registry system. They meticulously analyzed the children's pre-operative condition, surgical process, post-operative complications, and survival data, and used statistical methods (such as Kaplan-Meier survival analysis) to evaluate survival rates, while also comparing data between different age groups (2-11 years vs. 12-17 years) and hospitals with different surgical volumes. All transplanted organs came from voluntary donations after citizen death.

Limitations of the Study

The researchers frankly admitted that this study has some limitations. Firstly, the sample size is small (only 62 patients), which may affect the generalizability of some statistical results. Secondly, this is a retrospective study, and the completeness and accuracy of the data may be limited. Most importantly, the follow-up time of the study is short (most patients were followed up for about one year), making it impossible to evaluate the long-term survival rate and quality of life of pediatric lung transplantation. The long-term health status still requires longer observation.

Application Prospects and Outlook

This study is the first to provide a panoramic view of pediatric lung transplantation in China, and its significance is far-reaching. It not only confirms the feasibility of the surgery and good early survival outcomes but also provides valuable local data for clinicians, helping to optimize the selection of surgical indications and improve perioperative management strategies. The study results show that bronchiolitis obliterans syndrome is the main cause of pediatric lung transplantation, which suggests that we need to strengthen early intervention and management of such diseases. At the same time, the high survival rate found in the study will greatly enhance the confidence of affected children's families and doctors in performing lung transplantation. In the future, the research team calls for the establishment of a long-term follow-up cohort for pediatric lung transplantation to deeply explore key factors affecting long-term prognosis and to further improve pediatric lung transplantation guidelines and technical specifications that are in line with China's national conditions.

Summary

In summary, this study based on national registry data shows that China's pediatric lung transplantation endeavor, although still small in scale, is steadily progressing and has achieved encouraging early survival outcomes, even surpassing adult patients. Behind this are the arduous efforts of countless medical professionals and the continuous improvement of China's organ donation and allocation system. Although the future still faces many challenges such as donor shortage and long-term post-operative management, this study undoubtedly lights a beacon of hope for "free breathing" for children struggling with end-stage lung disease.