Lung transplant ‘effective treatment option’ for bronchopulmonary dysplasia

Key takeaways:

• Lung transplant-listed patients with BPD were younger and more were on mechanical ventilation vs. those with other lung diseases.
• Survival after transplantation did not differ between groups.

Patients with bronchopulmonary dysplasia who received a lung transplant showed survival rates comparable to those of transplant recipients with other lung diseases, according to results published in CHEST.

“Patients with bronchopulmonary dysplasia (BPD) have similar short- and long-term survival outcomes compared with patients undergoing lung transplant for other indications,” Alia Dani, MD, MPH, a postdoctoral research fellow in the department of cardiothoracic surgery at Cincinnati Children’s Hospital Medical Center at the time of the study and now a pediatric resident at UT Southwestern Medical Center in Dallas, and colleagues wrote. “Based on this analysis, lung transplant is an effective treatment option for patients with BPD, especially those with progressive decline in lung function.”

Using data from the United Network for Organ Sharing registry between 2000 and 2020 (n = 48,243), Dani and colleagues assessed 65 patients with BPD listed for lung transplantation to see if their characteristics, waitlist outcomes and survival rates after transplantation differed from lung transplant patients with other lung diseases in the registry.

Between the patients with BPD and patients with other diagnoses, researchers found significant differences in age (median age, 21 years; interquartile range [IQR], 5-31 vs. 57 years; IQR, 45-63; P < .001), mechanical ventilation use (23% vs. 3.7%; P < .001) and FEV₁ percent predicted (17% vs. 34%; P = .002).

Researchers noted an elevated prevalence of patients with BPD who were listed for a lung transplant and became recipients within the studied timeframe.

Median waitlist time (84 days vs. 77 days) and mortality rates while on the waitlist (6.2% vs. 10.8%) did not significantly differ between those with BPD and those with other diagnoses, according to researchers.

Thirty-two patients had BPD at the time of lung transplant and, again, these patients were younger (median age, 22 years; IQR, 7-34 vs. 58 years; IQR, 48-64) and a greater proportion were on mechanical ventilation (21.9% vs. 5.9%; P < .001 for both) compared with those with other lung diagnoses who underwent transplant (n = 35,379).

The rate of survival after transplantation was not significantly different between both groups of patients, with comparable rates at 1 year (BPD, 90% vs. other diagnoses, 86%), 3 years (81% vs. 69%) and 5 years (68% vs. 48%).

To further assess survival, researchers divided transplant recipients with BPD according to whether they were born before surfactant replacement therapy became widely available in 1990 (n = 19) or after surfactant (n = 16). Compared with those born before surfactant, those born after had a younger median age (7.5 years vs. 34 years; P < .001) and more required ventilation (n = 7 vs. 0; P = .001). However, survival outcomes did not differ between these groups.

Additionally, to control for risk factors, researchers used propensity scores to match patients with BPD who underwent bilateral lung transplantation (n = 33) to recipients with other diagnoses who underwent the same procedure (n = 33). Survival did not significantly differ between both groups.

“Clinicians caring for patients with BPD with progressive respiratory failure should consider lung transplantation,” Dani and colleagues wrote.