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The Nordic Experience of Pediatric Heart-Lung Transplantation

van der Have, Oscar LU orcid ; Odermarsky, Michal LU orcid ; Moller, Thomas ; Juul, Klaus ; Jahnukainen, Timo ; Weinreich, Ilse Duus ; Sarkola, Taisto ; Kaskinen, Anu K. ; Tran-Lundmark, Karin LU and Wahlander, Hakan (2026) In Clinical Transplantation 40(5).
Abstract
Background
Pediatric heart-lung transplantation (pHLTx) remains the only treatment option for children with significant and fixed elevation of pulmonary vascular resistance (PVR) in the setting of uncorrectable end-stage heart disease. We aimed to determine the characteristics, waiting list course and long-term outcomes for children listed for pHLTx within the Scandiatransplant region.

Methods
This was a multinational, retrospective observational cohort study comprising all children <18 years of age residing in Denmark, Estonia, Finland, Iceland, Norway and Sweden that were listed for pHLTx from January first 1987 until December 31st 2024. Data were extracted from the Scandiatransplant registry... (More)
Background
Pediatric heart-lung transplantation (pHLTx) remains the only treatment option for children with significant and fixed elevation of pulmonary vascular resistance (PVR) in the setting of uncorrectable end-stage heart disease. We aimed to determine the characteristics, waiting list course and long-term outcomes for children listed for pHLTx within the Scandiatransplant region.

Methods
This was a multinational, retrospective observational cohort study comprising all children <18 years of age residing in Denmark, Estonia, Finland, Iceland, Norway and Sweden that were listed for pHLTx from January first 1987 until December 31st 2024. Data were extracted from the Scandiatransplant registry database.

Results
Thirty-two children were listed for pHLTx during the study period. Seventeen (53.1%) reached transplantation with a peak in listing and transplantation during the 1990ies. Median age at listing was 12.1 years (range 1.5–17.6, IQR 7.6–15.8). No infants <1 year were listed for pHLTx and there was no re-listing for re-transplantation during the study period. Congenital heart disease (CHD) with Eisenmenger´s syndrome was the cause of listing and transplantation in most cases (60.7% and 58.8%, respectively). Median waiting list duration was 268 days (range 3–3409, IQR 109–822). All-cause posttransplant 30-day mortality was 17.6% (n = 3). Kaplan–Meier estimated survival was 76.5% at 1 year, 35.3% at 5 years and 23.5% at 10 years posttransplant.

Conclusion
Low numbers of pHLTx has been performed in Scandinavia. Long-term outcomes were unfavorable, but comparable to other larger international and North American registries. The declining number of performed pHLTx may result from a combination of poor prognosis, declining incidence of Eisenmenger´s syndrome, improved surgical techniques for cardiac repair combined with lung transplantation, and increasing use of lung transplantation for isolated pulmonary vascular disease.
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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
long-term outcomes, pediatric heart-lung transplantation, scandiatransplant
in
Clinical Transplantation
volume
40
issue
5
article number
e70570
publisher
Wiley-Blackwell
external identifiers
  • pmid:42157691
  • scopus:105039556865
ISSN
1399-0012
DOI
10.1111/ctr.70570
language
English
LU publication?
yes
id
631a6131-fd90-4bcd-9a16-a4865f50f499
date added to LUP
2026-05-20 13:36:07
date last changed
2026-08-13 04:02:26
@article{631a6131-fd90-4bcd-9a16-a4865f50f499,
  abstract     = {{Background<br/>Pediatric heart-lung transplantation (pHLTx) remains the only treatment option for children with significant and fixed elevation of pulmonary vascular resistance (PVR) in the setting of uncorrectable end-stage heart disease. We aimed to determine the characteristics, waiting list course and long-term outcomes for children listed for pHLTx within the Scandiatransplant region.<br/><br/>Methods<br/>This was a multinational, retrospective observational cohort study comprising all children &lt;18 years of age residing in Denmark, Estonia, Finland, Iceland, Norway and Sweden that were listed for pHLTx from January first 1987 until December 31st 2024. Data were extracted from the Scandiatransplant registry database.<br/><br/>Results<br/>Thirty-two children were listed for pHLTx during the study period. Seventeen (53.1%) reached transplantation with a peak in listing and transplantation during the 1990ies. Median age at listing was 12.1 years (range 1.5–17.6, IQR 7.6–15.8). No infants &lt;1 year were listed for pHLTx and there was no re-listing for re-transplantation during the study period. Congenital heart disease (CHD) with Eisenmenger´s syndrome was the cause of listing and transplantation in most cases (60.7% and 58.8%, respectively). Median waiting list duration was 268 days (range 3–3409, IQR 109–822). All-cause posttransplant 30-day mortality was 17.6% (n = 3). Kaplan–Meier estimated survival was 76.5% at 1 year, 35.3% at 5 years and 23.5% at 10 years posttransplant.<br/><br/>Conclusion<br/>Low numbers of pHLTx has been performed in Scandinavia. Long-term outcomes were unfavorable, but comparable to other larger international and North American registries. The declining number of performed pHLTx may result from a combination of poor prognosis, declining incidence of Eisenmenger´s syndrome, improved surgical techniques for cardiac repair combined with lung transplantation, and increasing use of lung transplantation for isolated pulmonary vascular disease.<br/>}},
  author       = {{van der Have, Oscar and Odermarsky, Michal and Moller, Thomas and Juul, Klaus and Jahnukainen, Timo and Weinreich, Ilse Duus and Sarkola, Taisto and Kaskinen, Anu K. and Tran-Lundmark, Karin and Wahlander, Hakan}},
  issn         = {{1399-0012}},
  keywords     = {{long-term outcomes; pediatric heart-lung transplantation; scandiatransplant}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{5}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Transplantation}},
  title        = {{The Nordic Experience of Pediatric Heart-Lung Transplantation}},
  url          = {{http://dx.doi.org/10.1111/ctr.70570}},
  doi          = {{10.1111/ctr.70570}},
  volume       = {{40}},
  year         = {{2026}},
}