{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T07:35:46Z","timestamp":1793000146962,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric lung transplantation (LTx) and multiorgan lung transplantation (MOLT) remain uncommon, and national data describing temporal trends and outcomes are limited. We characterized four decades of MOLT in the United States, with particular emphasis on the evolving pediatric experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files provided by the United Network for Organ Sharing from 1987 to 2024. The cohort included 54\u2009797 isolated LTx recipients and 1 963 MOLT recipients, classified into mutually exclusive groups of dual\u2010organ lung\u2010heart (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091557), lung\u2010liver (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009216), lung\u2010kidney (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009154), and other multiorgan configurations (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936). Cox regression, Fine\u2013Gray competing\u2010risks, landmark, and interaction analyses evaluated graft\u2010failure associations across four transplant eras and seven age groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pediatric transplant volume declined substantially, comprising 0.8% of isolated LTx procedures in 2020\u20132024. Lung\u2010heart transplantation decreased from 9.0% of lung\u2010involved procedures before 2000 to 1.8% in 2020\u20132024, whereas lung\u2010liver and lung\u2010kidney transplantation increased modestly, predominantly among adults. Pretransplant ECMO use increased across cohorts, reaching 27.6% among lung\u2010heart and 27.8% among lung\u2010kidney recipients in 2020\u20132024. One\u2010year graft survival improved progressively across eras.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pediatric MOLT has evolved within a changing national lung\u2010transplant landscape characterized by declining pediatric volume, shifting procedural patterns, increasing recipient acuity, and improving early graft outcomes. Continued evaluation is needed as long\u2010term follow\u2010up from recent eras matures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70466","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:26:08Z","timestamp":1792128368000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Multiorgan Lung Transplantation: Four Decades of National Trends and Outcomes"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1674-8801","authenticated-orcid":false,"given":"Carl","family":"Britto","sequence":"first","affiliation":[{"name":"Division of Medical Critical Care, Boston Children's Hospital, Department of Pediatrics, and Margaret C Ryan Global Health Program Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9319-6471","authenticated-orcid":false,"given":"Ali","family":"Demir","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7100-328X","authenticated-orcid":false,"given":"Eleanor D.","family":"Muise","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonary Medicine Hassenfeld Children's Hospital, NYU Langone Health  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Brian","family":"McAlvin","sequence":"additional","affiliation":[{"name":"Division of Medical Critical Care Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6734-6052","authenticated-orcid":false,"suffix":"Jr.","given":"Don","family":"Hayes","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Division of Pulmonary Medicine Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9635-488X","authenticated-orcid":false,"given":"Levent","family":"Midyat","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15677"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14634"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2024.01.017"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14086"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14562"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2018.07.016"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13682"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2024.13372"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14129"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2022.08.004"},{"issue":"2","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.ajt.2025.01.025","article-title":"OPTN\/SRTR 2023 annual data report: lung","volume":"25","author":"Valapour M.","year":"2025","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2022.08.001"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14505"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202009\u20101145OC"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(19)30490\u20108"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2024.08.012"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17123"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.05.018"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2025.08.005"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14570"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70466","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70466","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70466","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T07:26:09Z","timestamp":1792999569000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":20,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/petr.70466"],"URL":"https:\/\/doi.org\/10.1111\/petr.70466","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-08-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70466"}}