Extended Donor Criteria in Pediatric Heart Transplantation

Objectives: Despite considerable progress in heart transplantation, pediatric waiting list mortality is still high, and often children do not have enough time to wait for the perfect donor match.

Methods: In our center, we have performed 20 pediatric heart transplantation since 2014, 10 of them following so-called extended donor criteria (eHTX). We have retrospectively analyzed these 10 patients for donor–recipient weight ratio (DRWR <0.6 or >3.0) and chronological age mismatch (donor organ >5 years older than patient's chronological age) and studied preoperative status, postoperative course and early clinical follow-up and compared them with the other 10 children as controls (sHTX). We used two-tailed t-tests for comparisons.

Result: Three of the nine patients with >5 years older donors had also a size mismatch (mean DRWR, 3.81). One patient received a smaller heart for his size (DRWR: 0.44). Male/female proportion and mean age between case and control group were comparable. As bridge to transplantation, ECMO support was required by 60% of eHTx and 20% of sHTx patients (p = 0.074); VAD support did obtain 30% (eHTx) and 40% (sHTx, p = 0.66). Mean ventilation time and mean days in intensive care unit was also comparable: mean ventilation time 117.2 hours (eHTX), 105.7 hours (sHTX, p = 0.886); mean days ICU: 37.1 days (eHTX), 33.9 days (sHTX, p = 0.893). One patient in the eHTX group needed a postoperative ECMO support and had some related complications (hemothorax and circuit change). There were no significant early reinterventions in control group. All patients are now alive and in good clinical conditions (NYHA I). The freedom from first rejection episode is comparable between case and control group (60%); two patients from the sHTX group and none from eHTX group had a second episode. The incidence of posttransplantation lymphoproliferative disease is even comparable between case (30%) and control group (40%). One patient from eHTX group, who received a heart of a 60 years old donor, developed transplant vasculopathy after 15 months.

Conclusion: The postoperative course and early follow-up after pediatric heart transplantation using extended donor criteria were comparable to standard donor criteria. In poor clinical situations, therefore, reasonable extended donor criteria may be considered as an additional option for pediatric HTX.

Publication History

Article published online:
21 February 2021