Lung Transplantation for Bronchopulmonary Dysplasia

Dani, Alia; Hayes, Don; Guzman-Gomez, Amalia; Hossain, Md. Monir; Woods, Jason C.; Morales, D.L.; Hirsch, Russel; Zafar, Farhan; Hysinger, Erik B.

doi:10.1016/j.chest.2022.12.032

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…on ventilator support 43.4% versus 0%. 298 There were no statistically significant differences in survival post-lung transplant when comparing the BPD group to the group with other diagnoses nor was there a difference when comparing pre-SE and post-SE BPD patients. 298 While an extreme option, lung transplant could be considered for patients with progressive, life-limiting lung disease secondary to BPD.…”

mentioning

confidence: 72%

“…Between the years 2000-2020, a total of 37 patients with BPD as a diagnosis underwent a lung transplant. 298 Overall, these patients had a younger median age at the time of transplant when compared to other lung transplant recipients, 22 years (interquartile range (IQR) 7-34 years) versus 58 years (IQR 48-64 years), respectively. When comparing the BPD lung transplant recipients born in the pre-surfactant era (SE) to the post-SE, the post-SE patients were significantly younger, 7.5 years (IQR 1-13.35 years) versus 34 years (IQR 29-37 years).…”

Section: Established Bpd: > 36 Weeks Pma -Lung Transplantationmentioning

confidence: 89%

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Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

Gilfillan,

Mejia,

Bhandari

2024

RRN

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Bronchopulmonary dysplasia (BPD) is a complex pulmonary condition that arises in preterm infants secondary to a constellation of adverse exposures contributing to impaired lung development and repair. In many developed countries, the incidence of BPD continues to rise despite the increasing use of evidence-based therapies and efforts to minimize adverse post-natal exposures. Refinement of perinatal care practices that reduce mortality in the most immature infants is likely contributing to this trend; however, a growing population of survivors with respiratory morbidity significantly burdens individuals and health-care systems. Racial and socioeconomic disparities also result in unequal distribution of morbidity within society. In this review, we will outline trends in the incidence of BPD over the last decade and review important risk factors for adverse pulmonary outcomes. The consequences of BPD for long-term health will be described, followed by a comprehensive summary of evidence-based therapies and potential future treatments that can be applied to reduce the incidence, and the prevalence of BPD.

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confidence: 72%

Section: Established Bpd: > 36 Weeks Pma -Lung Transplantationmentioning

confidence: 89%

Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

Gilfillan,

Mejia,

Bhandari

2024

RRN

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“…Recent studies suggest that lung transplant in older children and adults with severe BPD is feasible and has comparable outcomes to patients with other lung diseases. [27][28][29] Infant lung transplantation, including recipients with grade 3 BPD, has shown encouraging outcomes. 30,31 In our cohort, the children had variable neurodevelopmental delays, with one having autism.…”

Section: Resultsmentioning

confidence: 99%

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Maynard,

Armstrong,

O'Grady

et al. 2024

Pediatric Pulmonology

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BackgroundPremature infants surviving beyond a postmenstrual age (PMA) of 36 weeks with severe or grade 3 bronchopulmonary dysplasia (sBPD) have significant predischarge mortality. The in‐hospital mortality for BPD supported by invasive mechanical ventilation beyond 36 weeks PMA is not well described. The role of lung transplantation in treating severe BPD is uncertain. We studied our experience over 20 years to better define the predischarge mortality of infants with progressive grade 3 BPD and whether lung transplant is a feasible intervention.MethodsData were obtained from a retrospective review of medical records from Children's Minnesota over a 20‐year period (1997–2016). Inclusion criteria included prematurity <32 weeks PMA, BPD, tracheostomy for chronic respiratory failure, and survival beyond 36 weeks PMA. Collected data included perinatal demographics, in‐hospital medications and interventions, level of respiratory support, and outcomes.ResultsIn all, 2374 infants were identified who survived beyond 36 weeks PMA with a diagnosis of <32 weeks gestation prematurity and BPD. Of these, 143/2374 (6.0%) survived beyond 36 weeks PMA and required invasive mechanical ventilation with subsequent tracheostomy for management. Among these patients, discharge to home with tracheostomy occurred in 127/143 (88.8%), and predischarge death or lung transplantation occurred in 16/143 (11.2%). Deteriorating cardiopulmonary status was associated with pulmonary hypertension, prolonged hypoxemic episodes and the need for deep sedation or neuromuscular relaxation. Three of four patients referred for lung transplantation had >5‐year survival, chronic allograft rejection, and mild to moderate developmental delays.ConclusionsChronic respiratory failure requiring invasive mechanical ventilation for grade 3 BPD is associated with significant morbidity and mortality. For selected patients and their families, timely referral for lung transplantation is a viable option for end‐stage grade 3 BPD. As in other infants receiving solid organ transplants, long‐term issues with co‐morbidities and special needs persist into childhood.

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“…Furthermore, the number of adult survivors of BPD requiring lung transplantation is on the rise. [115][116][117] These patients are at high risk of cardiopulmonary morbidity across the lifespan, but their disease course remains largely undescribed outside of childhood.…”

Section: Discussionmentioning

confidence: 99%

“…While gentler ventilation strategies, including the increasing use of noninvasive positive pressure ventilation, and mesenchymal stem cell therapy may reduce the incidence of BPD among neonates in the future, BPD continues to afflict 42% of all births at less than 28 weeks’ gestation in the United States. Furthermore, the number of adult survivors of BPD requiring lung transplantation is on the rise 115–117 . These patients are at high risk of cardiopulmonary morbidity across the lifespan, but their disease course remains largely undescribed outside of childhood.…”

Section: Discussionmentioning

confidence: 99%

Bronchopulmonary dysplasia in adults: Exploring pathogenesis and phenotype

Wozniak,

Makhoul,

Botros

2023

Pediatric Pulmonology

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This review highlights both the longstanding impact of bronchopulmonary dysplasia (BPD) on the health of adult survivors of prematurity and the pressing need for prospective, longitudinal studies of this population. Conservatively, there are an estimated 1,000,000 survivors of BPD in the United States alone. Unfortunately, most of the available literature regarding outcomes of lung disease due to prematurity naturally focuses on pediatric patients in early or middle childhood, and the relative amount of literature on adult survivors is scant. As the number of adult survivors of BPD continues to increase, it is essential that both adult and pediatric pulmonologists have a comprehensive understanding of the pathophysiology and underlying disease process, including the molecular signaling pathways and pro‐inflammatory modulators that contribute to the pathogenesis of BPD. We summarize the most common presenting symptoms for adults with BPD and identify the critical challenges adult pulmonologists face in managing the care of survivors of prematurity. Specifically, these challenges include the wide variability of the clinical presentation of adult patients, comorbid cardiopulmonary complications, and the paucity of longitudinal data available on these patients. Adult survivors of BPD have even required lung transplantation, indicating the high burden of morbidity that can result from premature birth and subsequent lung injury. In addition, we analyze the disparate symptoms and management approach to adults with “old” BPD versus “new” BPD. The aim of this review is to assist pulmonologists in understanding the underlying pathophysiology of BPD and to improve clinical recognition of this increasingly common pulmonary disease.

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Lung Transplantation for Bronchopulmonary Dysplasia

Cited by 3 publications

References 21 publications

Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Bronchopulmonary dysplasia in adults: Exploring pathogenesis and phenotype

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