Journal article
Early Outcomes in Pediatric Heart Transplantation Stratified by Donor Procurement Method
Annals of thoracic surgery short reports, Forthcoming
01 Aug 2026
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Abstract
Donation after circulatory death (DCD) heart transplantation has expanded rapidly in adults but remains limited compared to traditional donation after brain death (DBD) in pediatric practice due to technical, logistical, and ethical challenges. Therefore, we sought to evaluate early outcomes of DCD and DBD pediatric heart transplantation using a contemporary national cohort.
A retrospective cohort study was conducted using the United Network for Organ Sharing database. Pediatric recipients undergoing isolated heart transplantation between June 1, 2004 and September 30, 2025 were identified and stratified by procurement method. A contemporary cohort transplanted after January 1, 2024 was analyzed separately. Candidate, donor, and perioperative characteristics were compared while post-transplant survival was estimated using Kaplan–Meier analysis.
Among 8,359 pediatric heart transplant recipients during the study period, 52 received DCD allografts. DCD recipients were younger (7 vs 4 years, p<0.001) but otherwise similar to DBD recipients. DCD donors were also younger (9 vs 6 years, p=0.02) and more likely to be size-mismatched (12% vs 21%, p=0.06), although donor–recipient distance was greater (335 vs 429 miles, p=0.01). Perioperative outcomes were largely similar across groups. Kaplan Meier 3-year survival (87% vs 87%, p=0.65) and contemporary 1-year survival (100% vs 92%, p=0.24) was similar across groups.
Pediatric heart transplantation using DCD donors achieves comparable early survival to traditional DBD transplantation; however, these findings are limited by small sample size, evolving practice patterns, and registry-level data, and further study with greater power is warranted.
•DCD heart transplantation in pediatric recipients achieves comparable midterm survival to traditional DBD transplantation, supporting DCD as a viable strategy to expand the donor pool.•While DCD recipients experienced higher rates of post-transplant renal replacement therapy and longer hospitalizations, these differences did not translate into inferior graft survival or mortality.•No deaths were observed among DCD recipients in the contemporary cohort, though small sample size and registry-level data limitations warrant cautious interpretation and further study.
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Details
- Title
- Early Outcomes in Pediatric Heart Transplantation Stratified by Donor Procurement Method
- Creators
- Peter D ChoJohn P. White - University of California, Los AngelesJoseph Song - University of California, Los AngelesPeter D. Cho - Drexel University College of Medicine, Philadelphia, PA, USAHedwig Zappacosta - University of California, Los AngelesStephanie McKay - University of California, Los AngelesAlexey Abramov - University of California, Los AngelesReshma Biniwale - University of California, Los AngelesMalini Daniel - University of California, Los AngelesDonatello Telesca - University of California, Los AngelesAbbas Ardehali - University of California, Los AngelesMajid Husain - University of California, Los Angeles
- Publication Details
- Annals of thoracic surgery short reports, Forthcoming
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Other Identifier
- 991022201960204721