Dr. Christian Benden, a pediatric lung transplant specialist, described the future of children needing lung transplants as a reduction in the overall number of surgeries but an increasing challenge for more complex patients and the teams caring for them. He was speaking today at the 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) in Toronto.
Worldwide, fewer than 100 pediatric lung transplants are performed each year in patients under 18 years of age, compared with nearly 5,000 in adults. At his own institution, Boston Children’s Hospital, only two pediatric lung transplants were performed last year, a typical number for a program of about half a dozen in the United States.
“Pediatric lung transplantation has always been a niche field because there are so few cases,” said Dr. Benden, past president of ISHLT.
Cystic fibrosis: a field-changing success story
Historically, children with cystic fibrosis (CF)-related end-stage lung disease accounted for up to half of pediatric lung transplants in the United States and approximately two-thirds in Europe and Australia. This situation has changed dramatically with the advent of highly effective treatments that can correct the underlying protein defects in many CF patients.
Children as young as two years old, and in some cases pregnant women with CF, are being treated in utero to protect the fetus’s lungs.
“CF as an indication for lung transplantation in children will almost disappear,” Dr. Benden told the audience at ISHLT2026.
The number of infected people is decreasing, and the number of children getting sick is increasing.
Remaining transplant patients often have multisystem disease and severe cardiopulmonary dysfunction. The last three pediatric lung transplants performed at Boston Children’s Hospital all involved ECMO (extracorporeal membrane oxygenation) support before the transplant, a level of support that was once considered abnormal.
“This is becoming a daily habit,” he said.
One of our recent transplant recipients was an 11-pound infant, which highlights the technical and physiological challenges facing our team. ”
Christian Benden, International Heart and Lung Transplant Society
He said such complexity requires a highly specialized multidisciplinary team and close collaboration with other pediatric solid organ transplant programs (heart, liver, kidney) on immunosuppression strategies and infection management.
nurturing the next generation
Given the low surgical volume at most centers, training future generations of surgeons and allied health professionals is a pressing challenge for pediatric lung transplant programs.
“Pediatric lung transplant programs cannot operate in isolation,” Dr. Benden said. “These facilities should be closely linked to high-volume adult lung transplant centers and other pediatric transplant services to ensure appropriate clinical experience and shared learning.”
Experts at the symposium also discussed the optimal location for pediatric lung transplant programs.
- an independent children’s hospital that is optimized for pediatric care but has a very low transplant volume, or
- Because we are embedded within or closely affiliated with an adult lung transplant center, we are able to offer a high volume of procedures and a wide range of experience.
Dr. Benden cited examples such as Toronto, Hannover (Germany), and Melbourne, where pediatric programs directly benefit from established large-scale adult lung transplant services. However, he stopped short of advocating a uniform model.
“My take-home message is to evaluate local resources and find the best way to maintain training for current staff and future leaders,” he said. “There will not be a single solution that will fit all centers around the world.”
The number of children needing lung transplants is decreasing, but the procedure remains critically needed
The bottom line, Dr. Benden said, is that pediatric lung transplants will continue to be necessary, but rare and reserved for the most complex cases at a time when medical treatments are increasingly preventing children from developing end-stage lung disease.
“The question is no longer just ‘Can it be transplanted?'” he concluded. “It’s a question of, ‘Given the small number of children but the vastness of their needs, how can we build and maintain a team with the right skills?'”
ISHLT’s annual general meeting and academic sessions will be held from April 22nd to 25th at the Metro Toronto Convention Center in Toronto, Ontario, Canada.
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International Heart and Lung Transplant Society
