Pediatric Thoracic Multiorgan Transplantation in the United States

Purpose Thoracic multiorgan transplantations (TMOTx) are complex procedures that when performed in adults have shown similar survival to single organ transplantation (TX). The overall number of TMOTx has been gradually increasing, however, the absolute number remains low compared to single organ TX. In the pediatric population, TMOTx constitute only a small fraction of the total pediatric TXs performed. A national database was used to review the overall experience with pediatric TMOTx in the United States. Methods and Materials United Network of Organ Sharing database was queried through 2011 for pediatric (≤18y) TMOTx. Of the 2102 TMOTx, 238 (12%) were pediatric TMOTx: 181 (76%) were heart-lung TX, while others included heart-kidney (32,13%), lung-liver (11,5%), heart-liver (10,4%), heart-lung-liver (3,1%) and lung-kidney (1,1%). TMOTx accounted for 3% (238/7945) of the total pediatric thoracic TX performed. Results Analysis of outcomes shows that graft survival in combined heart-lung TX was similar to survival in lung-only TX (p=0.127) but was worse than in heart-only TX (p Figure 1 ). Similarly, graft survival for TMOTx involving lung, except lung-liver (p=0.05), was not different than lung-only survival ( Figure 2 ). Conclusions Thoracic multiorgan transplantation offers a promising option for pediatric patients with multiorgan failure, while combining abdominal organ transplant with heart or lung transplant does not portend a worse outcome. Although rare in the pediatric population, these procedures can be performed successfully with an expectation of similar graft survival to single organ transplantation.