(909) The Reality of Using DCD Donors in Pediatric Thoracic Transplantation

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S393 - S394
• Main Authors: Ahmed, H.F., Guzman-Gomez, A., Greenberg, J.W., Kulshrestha, K., Hogue, S., Kantemneni, E., Zafar, F., Morales, D.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.1021

In the US, the first pediatric donation after cardiac death (DCD) thoracic transplant was done in 2004; however, early difficulties led to minimal utilization of these donors. Recently, the shortage of traditional donors has led to renewed interest in using DCD donors to expand the donor pool. The present study was performed to characterize the current state of pediatric DCD heart and lung transplantation (HTx, LTx) in the US. Children (<18yo) who underwent HTx or LTx using DCD donors from June 2004-June 2022 were identified in the UNOS registry. Donor and recipient characteristics and post-transplant outcomes including survival were compared using Pearson's chi-squared test and Mood's median test. A total of 14 DCD recipients were identified: 7 (50%) HTx & 7 (50%) LTx. Donor and recipient demographics are described in Table 1. Five (71.4%) DCD HTx were done prior to 2011 and 2 (28.6%) were done in the past 2 years, with only one center performing more than 2 transplants. Six (85.7%) DCD HTx donors had LVEF over 60%. Four of their respective recipients had a diagnosis of CHD (57.1%) and four had renal dysfunction (57.1%). Two (28.5%) LTx were done prior to 2007, whereas 5 (71.4%) were done after 2013. DCD LTx was mostly performed in adult size recipients (median weight 51 kg [30-58]) without renal (0%) or hepatic (0%) dysfunction and with low rates of ventilator support pre-tx 1 (14.3%). Three (42.9%) had a diagnosis of cystic fibrosis, 2 (28.6%) had PHTN & 2 (28.6%) had ARDS/pneumonia. One and five-yr post-transplant survival were as follows: HTx recipients (64% for each) and LTx recipients (86%, 55%). Although often discussed, the national experience with DCD donors for pediatric heart & lung transplantation remains limited and not being practiced consistently by any pediatric program. Further investigation is necessary to identify appropriate use of these potential donors.