Pediatric lung transplants decline as case complexity intensifies

In the future, there will be fewer operations overall performed on children in need of lung transplants, but more complex cases and mounting challenges will emerge, according to recent data presented by Christian Benden, MD, pediatric lung transplant specialist from Boston Children’s Hospital.¹

These findings were presented at the 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation in Toronto, Cananda, on April 22, 2026. During this presentation, Benden highlighted an annual number of pediatric heart transplants less than 500 worldwide, vs nearly 5000 transplants in adult patients.

“Pediatric lung transplantation has always been a niche because the numbers are very small,” said Benden.

Reduced case volume linked to CF therapies

At Boston Children’s Hospital, only 2 pediatric procedures were performed in 2025. This is the average volume reported by the half dozen programs in the United States. The reduction in pediatric lung transplants may be linked to the rise in highly effective therapies for children with cystic fibrosis (CF)–related end-stage lung disease.

Traditionally, this population accounted for up to half of US pediatric lung transplants, alongside approximately 2 in 3 transplants in Europe and Australia. New therapies have allowed the underlying protein defect in many of these patients to be resolved, providing treatment for children aged as young as 2 years.

Additionally, pregnant women with CF may be treated in utero, protecting their unborn children. According to Benden, this will lead CF to mostly disappear as an indication for pediatric lung transplant.

Rising complexity in remaining cases

Multi-system disease and severe cardiopulmonary compromise have made up most of the remaining pediatric lung transplant cases. Support on extracorporeal membrane oxygenation was reported for the past 3 cases at Boston Children’s Hospital, which experts once considered to be an extraordinary level of support.

According to Benden, this practice is becoming routine. Technological and physiological challenges have also emerged, such as one of the recent transplant cases being an 11-pound infant.

Bended highlighted the need for specialized, multidisciplinary teams to handle these complex cases. Additionally, immunosuppression strategies and infection management should be discussed with other pediatric solid organ transplant programs such as heart, liver, and kidney.

Recommended strategies for care

Based on these challenges, it is vital to train future generations of surgeons and allied health professionals. Benden also recommended linking pediatric lung transplant programs to high‑volume adult lung transplant centers and other pediatric transplant services.

Experts have also highlighted the best locations for pediatric lung transplant programs. These include:

• In stand-alone children’s hospitals
• Embedded within or closely linked to adult lung transplant centers

Overall, while pediatric lung transplant cases will remain rare, they are still necessary to treat the most complex cases. Therefore, clinicians should no longer just ask whether they can perform a lung transplant, but also how to build and sustain teams with the appropriate skills.

“My take‑home message is to assess your local resources, and then find the best way to maintain training for current staff and future leaders,” said Benden. “There won’t be a single solution that fits every center around the world.”

Evolution of lung transplants

The evolution of lung transplant procedures has been highlighted by David Rosenthal, MD, director at Stanford Medicine Children’s Health, in an interview with Contemporary Pediatrics.² According to Rosenthal, lung transplants are undergoing a similar evolution to the one observed in heart transplants.

Survival in heart transplants was once measured in weeks but evolved over time. Now, infants receiving a heart transplant are expected to survive for more than 2 decades. Lung transplants have begun evolving as well, improving their effectiveness.

“We’ve made steady strides and are hoping for a similar trajectory to the progress with heart transplants,” said Rosenthal.

References

1. Fewer surgeries, more complex cases in the future for pediatric lung transplantation. International Society for Heart and Lung Transplantation. April 22, 2026. Accessed April 23, 2026. https://www.eurekalert.org/news-releases/1124724
2. Fitch J. Transplants: How far have we come and how can pediatricians play a role? Contemporary Pediatrics. August 5, 2024. Accessed April 23, 2026. https://www.contemporarypediatrics.com/view/transplants-how-far-have-we-come-and-how-can-pediatricians-play-a-role-