Excellent Long-Term Outcomes in Paediatric Lung Transplantation Within a Centralised, Co-located Adult Program

Background: Paediatric lung transplantation (LTx) is a low-volume, high-complexity intervention with outcomes that remain inferior to adults internationally (median survival 6–7 years). In Australia, care is delivered through a nationally centralised program co-located within a high-volume adult lLTx centre, facilitating concentration of expertise, access to advanced therapies, and coordinated multidisciplinary care. We evaluated long-term outcomes within this model.
Methods: We conducted a retrospective cohort study of all patients aged <16 years undergoing lung or heart–lung transplantation at Australia’s national centre between June 2006 and June 2025. Survival was estimated using Kaplan–Meier methods.
Results: A total of 64 paediatric transplants were performed (56 bilateral lung, 8 heart–lung), with a median age of 14 years. Recipients were referred nationally, reflecting complete population capture. Indications included cystic fibrosis (n=21), pulmonary arterial hypertension (n=15), interstitial lung disease (n=9), and post–bone marrow transplant graft-versus-host disease (n=6) with additional rare conditions represented.
Management frequently required advanced strategies facilitated by co-location within an adult program, including size-reduced or lobar grafts (n=14), donation after circulatory death donors (n=12), the use of donors aged >18 years (n=34) and extracorporeal membrane oxygenation bridging (n=7).
Survival was 90.6% (95% CI 83.8–98.1) at 1 year, 68.9% (58.1–81.6) at 3 years, and 60.9% (49.4–75.0) at 5 years. Median survival was 9.0 years (95% CI 4.62–13.08), exceeding international benchmarks.
Conclusions: A nationally centralised, co-located adult–paediatric transplant model achieves excellent long-term outcomes in paediatric LTx, outperforming international benchmarks despite high case complexity. This approach enables equitable national access, concentration of expertise, and utilisation of advanced surgical and perioperative strategies. Centralisation within an adult program may be a key determinant of improved outcomes in rare paediatric transplant populations.