Pediatric Lung Transplantation Following Non-Transplant Cardiac Surgery: A Contemporary Analysis

PURPOSE: More children are undergoing congenital or non-congenital cardiac surgery today which can impact outcomes for subsequent thoracic surgery. However, post-lung transplant (LTx) outcomes of children with previous cardiac surgery are unknown, so we explored this important issue using a publicly available database. METHODS: A retrospective analysis was performed using the Scientific Registry of Transplant Recipients (SRTR). First-time pediatric LTx candidates without and with history of prior cardiac surgery, excluding previous cardiothoracic transplantation, from 2003 to 2024 were enrolled into our study. Univariate analyses, multivariable Cox regression, and Kaplan-Meier plots were performed for a comprehensive analysis. RESULTS: We identified 1333 and 144 LTx candidates without and with prior cardiac surgery (52 with congenital surgery, 92 with non-congenital surgery) with more children with cardiac surgery being listed for LTx over time. There were 811 LTx recipients without prior cardiac surgery compared to 63 with prior cardiac surgery (14 congenital, 49 non-congenital). Children with prior congenital cardiac surgery were much younger, and pulmonary vascular disease (PVD) was the most common indication for LTx. Prior non-congenital cardiac surgery did not negatively impact short- or long-term post-LTx outcomes in children. However, history of congenital cardiac surgery was associated with high waitlist mortality (31% compared to 15% (no surgery) and 21% (non-congenital surgery), p < 0.001) and worse long-term outcomes (HR 1.89; 95% CI 1.01, 3.53, p = 0.048). CONCLUSIONS: There is an increasing number of children with previous cardiac surgery undergoing LTx especially in the setting of congenital heart disease with subsequent PVD.