Pediatric heart transplantation following donation after circulatory death, distant procurement, and ex-situ perfusion
Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:41 |
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| Enthalten in: |
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation - 41(2022), 8 vom: 15. Aug., Seite 1104-1113 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Laurence, Craig [VerfasserIn] |
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| Links: |
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| Themen: |
Direct procurement and perfusion |
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| Anmerkungen: |
Date Completed 27.07.2022 Date Revised 04.10.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.healun.2022.04.013 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM341635855 |
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| 500 | |a Date Revised 04.10.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Donation after cardiac death | |
| 650 | 4 | |a Heart Transplant | |
| 650 | 4 | |a direct procurement and perfusion | |
| 650 | 4 | |a ex-situ perfusion | |
| 650 | 4 | |a pediatric transplant | |
| 700 | 1 | |a Nachum, Eyal |e verfasserin |4 aut | |
| 700 | 1 | |a Henwood, Sophie |e verfasserin |4 aut | |
| 700 | 1 | |a Berman, Marius |e verfasserin |4 aut | |
| 700 | 1 | |a Large, Stephen R |e verfasserin |4 aut | |
| 700 | 1 | |a Messer, Simon |e verfasserin |4 aut | |
| 700 | 1 | |a Kaul, Pradeep |e verfasserin |4 aut | |
| 700 | 1 | |a Baxter, Jen |e verfasserin |4 aut | |
| 700 | 1 | |a Quigley, Richard |e verfasserin |4 aut | |
| 700 | 1 | |a Osman, Mohamed |e verfasserin |4 aut | |
| 700 | 1 | |a Muthialu, Nagarajan |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Ben |e verfasserin |4 aut | |
| 700 | 1 | |a Bohuta, Lyubomir |e verfasserin |4 aut | |
| 700 | 1 | |a Kostolny, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Burch, Michael |e verfasserin |4 aut | |
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| 700 | 1 | |a Andrews, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Thiruchelvam, Timothy |e verfasserin |4 aut | |
| 700 | 1 | |a Hoskote, Aparna |e verfasserin |4 aut | |
| 700 | 1 | |a Simmonds, Jacob |e verfasserin |4 aut | |
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