Indications for pediatric lung transplantation in 2025: A new era
Bibliographic record
Abstract
The year 2025 marks an important landmark: almost 40 years since the first pediatric lung transplant (LTX), over 3-5 years since the availability of elexacaftor/tezacaftor/ivacaftor in several countries, and 5-10 years since striking shifts were reported in the diagnoses that accounted for pediatric LTX. We review historic indications for pediatric LTX, highlighting shifts in these over time, and analyze data from the ISHLT International Thoracic Organ Transplant Registry, United Network of Organ Sharing, Canadian Cystic Fibrosis (CF) Registry, and other databases up to the present day. Currently, pediatric CF-related LTX cases are at record lows in many countries. Non-retransplant bronchiolitis obliterans seems to be on the rise as a transplant indication in pediatrics, which is particularly true in the younger age group per ISHLT data. Childhood interstitial lung disease is increasing as an indication, especially in North America. Idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension as a whole now account for record highs as indications for pediatric LTX around the world, with IPAH alone now accounting for nearly 20% of pediatric LTX in the United States, for instance. This information will help guide future international pediatric thoracic transplant consensus guidelines around candidate selection and optimization, placing more emphasis on non-CF considerations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".