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Incidence of Severe PGD in Pediatric Heart Transplantation Using DCD vs. DBD Donor Hearts
Abstract   Peer reviewed

Incidence of Severe PGD in Pediatric Heart Transplantation Using DCD vs. DBD Donor Hearts

J. Song, J. White, S. McKay, P. Cho, H. Zappacosta, M. Daniel, A. Abramov, A. Ardehali and M. Husain
The Journal of heart and lung transplantation, v 45(5), pp 121-121
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.258

Abstract

Purpose: Donation after circulatory death (DCD) is increasingly adopted in pediatric heart transplantation, yet comparative data on early graft function versus donation after brain death (DBD) remain limited. This study evaluates the incidence and predictors of severe primary graft dysfunction (PGD) by donor type. Methods: The United Network for Organ Sharing database was queried for pediatric (<18 years) isolated heart transplants from September 2023 to June 2025. Recipients were stratified by donor type (DCD vs. DBD). Severe PGD was defined per the 2014 ISHLT consensus as left or biventricular dysfunction within 24 hours post-transplantation requiring mechanical circulatory support. The primary outcome was severe PGD at 24 hours; secondary outcomes included PGD at 72 hours, acute rejection, and in-hospital mortality. Group comparisons used chi-square or Fisher’s exact tests. Candidate predictors (p < 0.15) were screened using LASSO and subsequently entered into a multivariable logistic regression model to identify independent correlates of PGD. Results: Among 887 pediatric recipients, 34 (3.8%) received DCD hearts. DCD recipients were more frequently in the ICU at transplant (53.6% vs. 42.8%, p = 0.034), less likely to have LVAD support (19.2% vs. 40.2%), and had greater donor-recipient distance (444 vs. 300 nautical miles, p < 0.001). Severe PGD at 24 hours occurred in 14.8% of DCD and 5.5% of DBD recipients (p = 0.041), while PGD at 72 hours (5.9% vs. 2.9%, p = 0.33) and acute rejection (8.0% vs. 11.0%, p = 0.63) were similar. Median post-transplant stay was longer for DCD recipients (33 vs. 21 days, p = 0.017). DCD donor status was not independently associated with PGD at 24 hours (OR 1.99, 95% CI 0.56-7.13, p = 0.29). Conclusion: Although DCD recipients exhibited higher unadjusted PGD rates, multivariable analysis found no independent association between DCD status and severe PGD. These findings support the feasibility of pediatric DCD heart transplantation, warranting further longitudinal evaluation.

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