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Lung transplantation (LT) has become the standard of care in selected children with end-stage parenchymal and vascular pulmonary diseases. In patients with pulmonary hypertension (PH) and cystic fibrosis (CF), new highly effective medical therapies have extended the period before lung transplantation is needed. These innovations will change pediatric LT indications and candidate outcomes. This study aimed to examine waitlist outcomes and posttransplant survival in pediatric lung transplant candidates listed during the 2010-2020 period in France. All candidates registered on the national waiting list before 18 years old between January 2010 and December 2020 were included in this cohort study using the national registry Cristal. Candidate demographics, primary diagnosis, clinical status and laboratory values were analyzed. Cumulative incidence of transplantation and waitlist mortality were estimated with the competing risk analysis with transplantation and death or delisting for worsening medical condition as the competing events. Posttransplant survival curve was estimated using the Kaplan-Meier method. Univariate analyses were performed to identify variables associated with outcomes. The 139 listings in 131 candidates resulted in 121 LT. At listing, 122 candidates were ≥11 years of age, 76 were females, 84 had CF, 35 pulmonary fibrosis (PF) and 16 PH, 80 were CMV-negative, 63 had HLA alloantibodies, 73 were hospitalized, 15 were on ECMO support, 4 had mechanical ventilation without ECMO, 61 were with high-urgency status. Cumulative incidence of transplantation and death or delisting for medical condition at 12-month was 80% [72-86] and 7% [4-13], respectively. ECMO support was associated with waitlist mortality. At transplant, 110 candidates were ≥11 years of age, 76 had CF, 28 PF and 14 PH, 54 had HLA alloantibodies, 73 were hospitalized, 21 were on ECMO support, 4 had mechanical ventilation without ECMO. One-year posttransplant survival was 82%. Pretransplant ECMO and mechanical ventilation, and donor-recipient height ratio >1.2 were associated with posttransplant mortality. Our findings will be useful for evaluation of the impact of new medical therapies on future indications and results of pediatric LT. [ABSTRACT FROM AUTHOR]

To address the shortage of pediatric donor lungs the French lung allocation system assigns priority status to pediatric candidates. Consequently, pediatric candidates frequently receive organ from adult donors. An association between donor age and posttransplant mortality has been shown in adult lung recipients. This study aimed to evaluate the effect of donor age on posttransplant mortality in pediatric lung recipients All candidates registered on the national waiting list before 18 years old between January, 1st 2010 and December 31st 2020 who underwent transplantation were included in this cohort study using the national registry Cristal. Recipient characteristics at transplant in addition to donor characteristics were analyzed. 1-year posttransplant survival was estimated by the Kaplan-Meier method. Cubic spline model was used to evaluate the association between donor age as continuous variable and 1-year posttransplant mortality. Of the 121 transplant recipients (55 males, 11+ years n=110, cystic fibrosis n=76, pulmonary fibrosis n=28, pulmonary hypertension n=14, bronchiectasis n=3) 21 were on extracorporeal membrane oxygenation (ECMO), 4 on mechanical ventilation without ECMO at transplant. Among donors, 76 were female, cerebrovascular accident and head trauma were the cause of death in 60 and 35 respectively, 17 had PaO2/FiO2 ratio <350 mmHg, 56 were CMV-positive, 40 had cardiopulmonary resuscitation and 96 (79%) were >17 years old. One-year posttransplant survival was 82%. Pretransplant ECMO and mechanical ventilation without ECMO, and donor-recipient height ratio >1.2 were associated with posttransplant mortality. Donor age was not associated with hazard ratio for 1-year mortality (Figure). Allocation of adult donor lungs to elective and urgent pediatric candidates through pediatric priority status can address the shortage of pediatric donor organs without affecting posttransplant outcomes. [ABSTRACT FROM AUTHOR]