| Description |
- Background & Hypothesis: Demand for pediatric heart transplants exceeds the supply of available organs, resulting in an average waiting time of six months and significant waitlist mortality. The use of donor hearts after circulatory death (DCD) promises to expand the donor pool. We hypothesized that the utilization of in situ perfusion of donor hearts will allow for the implantation of quality organs and increased utilization of available donor hearts. Here, we present our early single-center experience with pediatric heart transplantation using DCD donors based on normothermic regional perfusion (NRP).
Methods & Results: Pediatric patients (<2 years old) who underwent heart transplantation from DCD donors at Duke University Hospital were identified. Donor hearts were reanimated in situ utilizing a mobile extracorporeal membrane oxygenator platform for thoracic NRP and subsequently transported using static cold storage. Recipient and donor characteristics were collected, and patient outcomes were analyzed. Five recipients were identified (Table 1) with a median age of 6.9 (range 2-15) months. Indications for cardiac transplant included ischemic cardiomyopathy (2/5), hypoplastic left heart syndrome (2/5), and histiocytoid cardiomyopathy (1/5). Median total donor warm ischemic time (WIT) was 305 (244-344) minutes, and median donor cold ischemic time (CIT) was 206 (76-245) minutes. Median total implant time was 225 (214-284) minutes, with a median operative time of 370 (241-450) minutes. Median overall ICU and hospital lengths of stay were 22.5 (11-32) and 128.5 (69-155) days, respectively. Left ventricular systolic function ranged from mildly decreased to normal at discharge. One patient remains hospitalized. Median follow-up duration is 4.15 (3.4-13.1) months with no loss to follow-up and no deaths.
Conclusions: The ability to perfuse the heart in situ until cardiac evaluation is completed, is crucial in reducing WIT and ensuring quality organs for implantation. Utilization of DCD donors procured using thoracic NRP is a promising strategy for use in pediatric heart transplantation, resulting in excellent outcomes while addressing the critical demand for organs.
Table 1: Recipient Characteristics and Outcomes
Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Sex F M M M M
Age (months) 6 15 3 2 6
Transplant Indication Histiocytoid cardiomyopathy Hypoplastic left heart syndrome Ischemic dilated cardiomyopathy Hypoplastic left heart syndrome Ischemic cardiomyopathy
Donor WIT from SBP <50 or ½ T0 (minutes) 22 56 31 77 130
Donor WIT from SaO2 <70% (minutes) 45 58 30 77 135
Total WIT (minutes) 244 340 256 305 344
Donor CIT (minutes) 200 224 206 245 76
Implant Time (minutes) 222 284 225 228 214
Total Operative Time (minutes) 450 370 241 405 356
ICU Length of Stay (days) 32 19 26 Currently hospitalized 11
Total Hospital Length of Stay (days) 155 135 122 Currently hospitalized 69
CIT, cold ischemic time; SaO2, oxygen saturation; SBP, systolic blood pressure; WIT, warm ischemic time.
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