Pediatric heart transplant in donation after circulatory death using normothermic regional perfusion.
| Title: | Pediatric heart transplant in donation after circulatory death using normothermic regional perfusion. |
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| Authors: | Overbey DM; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC; Duke Children's Pediatric and Congenital Heart Center, Durham, NC. Electronic address: douglas.overbey@duke.edu.; Kucera JA; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC.; Aykut B; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC.; Wolf SEM; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC.; Gambino RM; Division of Perfusion Services, Duke University Medical Center, Durham, NC.; Medina CK; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC.; Shea EV; Pediatric Cardiology, Duke University Medical Center, Durham, NC.; Schroder JN; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.; Turek JW; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC; Duke Children's Pediatric and Congenital Heart Center, Durham, NC. |
| Source: | The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2025 Oct; Vol. 170 (4), pp. 1170-1175.e1. Date of Electronic Publication: 2025 Jun 20. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: St. Louis, MO : Mosby; Original Publication: St. Louis. |
| MeSH Terms: | Heart Transplantation*/adverse effects ; Heart Transplantation*/mortality ; Heart Transplantation*/methods ; Perfusion*/methods ; Perfusion*/adverse effects ; Perfusion*/mortality ; Tissue Donors*/supply & distribution ; Heart Failure*/surgery ; Heart Failure*/physiopathology ; Heart Failure*/mortality ; Heart Failure*/diagnosis ; Tissue and Organ Procurement*/methods; Graft Rejection/etiology ; Primary Graft Dysfunction/etiology ; Humans ; Female ; Child ; Male ; Child, Preschool ; Waiting Lists ; Adolescent ; Time Factors ; Treatment Outcome ; Infant ; Brain Death ; Graft Survival |
| Abstract: | Objective: Orthotopic heart transplant is the definitive option for pediatric patients with end-stage heart failure. Unfortunately, the greatest contributor to waitlist mortality has been a shortage of available hearts for transplant. Donation after circulatory death with normothermic regional perfusion may mitigate this supply-demand mismatch.; Methods: Donation after circulatory death with normothermic regional perfusion recipients were matched to similar donation after brain death recipients. Primary end points included 1-year survival and episodes of primary graft dysfunction at 1 year. Secondary end points included treated rejection at 1 year and ventricular systolic and diastolic function on echocardiogram at time of discharge. Elevated filling pressures or decreased cardiac output were also examined via cardiac catheterization data at time of endomyocardial biopsy at 1 year.; Results: Twelve donation after circulatory death procurements were attempted and 9 hearts procured. Donor cardiac arrest and cardiac function before procurement were similar in both groups. Donation after brain death recipients spent more time on the waitlist. After transplant, biventricular function was similar in both groups at time of discharge and at 1-year follow-up. There were no differences between groups with regard to primary graft dysfunction or instances of treated rejection at 1 year.; Conclusions: This study represents the largest single-institution cohort of pediatric recipients of hearts obtained after donation after circulatory death with normothermic regional perfusion compared with demographically similar donation after brain death cardiac transplant recipients. These results are indicative of equivalent outcomes at 1-year, suggesting that donation after circulatory death with normothermic regional perfusion is a viable method to expand the pediatric cardiac donor pool.; (Copyright © 2025. Published by Elsevier Inc.) |
| Competing Interests: | Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. |
| Contributed Indexing: | Keywords: DCD-NRP; pediatric orthotopic transplant |
| Entry Date(s): | Date Created: 20250622 Date Completed: 20251002 Latest Revision: 20260325 |
| Update Code: | 20260326 |
| DOI: | 10.1016/j.jtcvs.2025.06.015 |
| PMID: | 40545233 |
| Database: | MEDLINE |
Journal Article