Lung Transplantation for Bronchopulmonary Dysplasia

Abstract

Background: Patients with bronchopulmonary dysplasia (BPD) have poor respiratory trajectories and are at increased risk of lung function decline with age. Lung transplant (LTx) is a possible treatment option for this growing patient population, but little has been published on LTx in this patient group.

Research question: What are the characteristics of patients with BPD who are listed for LTx? How do waitlist and post-LTx outcomes for BPD compare with LTx for other diagnoses?

Study design and methods: The United Network for Organ Sharing (UNOS) registry was queried for patients of all ages listed for or who underwent LTx (2000-2020). Descriptive analysis, waitlist outcomes, and post-LTx survival at 1, 5, and 10 years were assessed comparing patients with BPD vs LTx patients with other diagnoses. Post-LTx survival for patients with BPD born in the pre-surfactant era (pre-SE, before 1990) and those born in the post-surfactant era (post-SE) was compared. Propensity score matching was performed to control for the risk factors and match patients with BPD with other LTx patients on a 1:1 ratio.

Results: BPD was reported in 65 patients, of whom 32 (49.2%) underwent LTx. Patients with BPD at listing were younger than those with other diagnoses (median age, 21 [interquartile range, 5-31] years vs 57 [45-63] years; P < .001), and more were likely to receive mechanical ventilation at listing (23% vs 3.7%; P < .001). Patients with BPD had an FEV₁ of 17% compared with 34% predicted in other patients (P = .002). Patients with BPD had an overall similar post-LTx survival compared with patients with other diagnoses (P = .106), even following propensity score matching (P = .41).

Interpretation: LTx for BPD has increased over the last 20 years. Patients with BPD have similar post-LTx outcomes compared with those of other patient populations in the modern era. Thus, LTx could be considered for patients with BPD experiencing progressive respiratory deterioration.

Keywords: COPD; bronchopulmonary dysplasia; lung transplant.

Figure 1

Cohort selection flowchart from the UNOS registry (2000-2020). BPD = bronchopulmonary dysplasia; LTx = lung transplant; Tx = transplant; UNOS = United Network for Organ Sharing.

Figure 2

A, Frequency of patients listed for an LTx who were diagnosed with bronchopulmonary dysplasia at listing, per year of listing (January 2000-September 2020). B, Frequency of patients undergoing an LTx diagnosed with bronchopulmonary dysplasia at time of transplant, per year of transplant (2004-2020). IQR = interquartile range; LTx = lung transplant.

Figure 3

Kaplan-Meier survival curves showing posttransplantation analysis of patients receiving a lung transplant with a BPD diagnosis vs other diagnosis. Patients with BPD have similar-to-better overall survival than other patients (P = .106). BPD = bronchopulmonary dysplasia.

Figure 4

Kaplan-Meier survival curves showing posttransplantation analysis of patients with bronchopulmonary dysplasia born in the Post-SE receiving LTx vs those born in the Pre-SE. There is no difference in survival between patients born in Pre-SE vs Post-SE (P = .09). Post-SE = post-surfactant era; Pre-SE = pre-surfactant era.

Figure 5

Kaplan-Meier survival curves showing posttransplantation analysis of matched double-lung transplant patients receiving a lung transplant who had a BPD diagnosis vs other diagnosis. After matching for age, lung allocation score, ventilator support, and era, patients with BPD appear to have similar overall and 1-, 3-, and 5-y survival compared with patients with other diagnoses (P = .41). BPD = bronchopulmonary dysplasia.