Background
Limited availability of suitable donor hearts remains a challenge to pediatric heart
transplantation, contributing to waitlist mortality. Controlled donation after circulatory
death (DCD) has demonstrated success in adults. Early series of pediatric DCD heart
transplantation using cold storage alone reported significant early mortality. We
report a collaboration between 2 centers in the United Kingdom, combining expertise
in adult DCD organ retrieval and pediatric transplantation.
Methods
This retrospective series comprises 6 children (4 male, all >20 kg) undergoing DCD
heart transplantation at Great Ormond Street Hospital between 1 February and 30 September
2020, following retrieval with direct procurement and perfusion using portable normothermic
machine perfusion by the Royal Papworth Hospital service. Baseline characteristics
and 1-year follow-up were compared to 9 children who underwent donation after brain
death (DBD) transplants contemporaneously.
Results
Mean DCD donor age was 24.67 years and mean DCD recipient age was 13.83 years. Mean
functional warm ischemic time was 28.5 minutes and ex-situ heart perfusion time was
280 minutes. Median ICU and hospital stay were 9 and 17 days, respectively. All children
survived to 1-year post-transplant. Survival and ICU and hospital stay were similar
between the DCD and DBD cohorts. Performing DCD transplants resulted in a 66.7% increase
in transplants for children >20 kg at GOSH during the study.
Conclusions
This series demonstrates that DCD heart transplant can be performed safely with excellent
short-term survival in children. Although the cohort is small, there was no significant
difference in major outcomes compared to a DBD cohort.
KEYWORDS
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Article info
Publication history
Published online: May 03, 2022
Identification
Copyright
Crown Copyright © 2022. Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved.
