Early Single Center Experience With An Ex Vivo Organ Care System In Pediatric Heart Transplantation
Cathlyn Medina, BA, Douglas M. Overbey, MD, MPH, Lauren E. Parker, BS, Neel K. Prabhu, MD, Lillian Kang, MD, Ziv Beckerman, MD, Jacob N. Schroder, MD, Joseph W. Turek, MD, MBA, PhD.
Duke University, Durham, NC, USA.
Objective(s): Pediatric heart transplantation (HTx) presents several unique challenges, including limited donors in a geographic area and the need for additional procedures in recipients with congenital anomalies. Ex vivo perfusion could address these by decreasing ischemic time. Here, we describe our early single-center experience with ex vivo perfusion in pediatric HTx. Methods: Pediatric patients who received ex vivo perfused donor hearts from 2020-2023 were identified. Donor hearts were placed on the TransMedics Organ Care System (OCS) device in donation after brain death or circulatory death. Outcomes were analyzed. Results: Five recipients were identified (Table 1). Median recipient age was 14 (range 13-18) years. Indications for transplant included dilated cardiomyopathy (4/5) and Fontan failure (1/5). Median OCS time was 254 (195-296) minutes. Median operative time was 496 (454-740) minutes, with the Fontan patient having the longest time of 740 minutes. There was no severe graft dysfunction requiring mechanical circulatory support. Median ICU and hospital length of stay were 36 (6-101) and 65 (13-113) days, respectively. Left ventricular systolic function ranged from mildly decreased-normal at discharge. Median follow-up duration is 6 (1.5-34.6) months with no loss to follow-up and no deaths. Conclusions: Ex vivo perfusion is an underutilized but viable option in pediatric HTx. This technique may expand the donor pool by enabling access to distant organs and decreasing cold ischemic time to enable complex reconstructions. 
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