Early single-center experience with an ex vivo organ care system in pediatric heart transplantation

Abstract

Pediatric heart transplantation (HTx) faces challenges such as limited donor availability and the need for complex reconstructions, particularly in patients with congenital anomalies. Ex vivo perfusion offers a promising approach to minimize graft ischemic time and potentially expand the donor pool. We report our single-center experience using the TransMedics Organ Care System (OCS) for ex vivo perfusion in pediatric HTx. From 2020 to 2024, 8 pediatric patients received OCS-perfused donor hearts. The median recipient age was 13 years (range 9-18), and the median weight was 58.8 kg (33.2-127.8). Indications for HTx included dilated cardiomyopathy (n = 4), hypertrophic cardiomyopathy (n = 1), graft vasculopathy (n = 1), and Fontan failure (n = 2). Median OCS time was 273 minutes (195-328), and recipient ischemic time was 85 minutes (64-139). Post-transplant, all patients had normal LV function at discharge. Over a median follow-up of 11.9 months, there were no deaths. These findings suggest that ex vivo perfusion is a valuable technique in pediatric HTx.

Keywords: congenital heart disease; heart transplantation; organ care system; pediatric heart transplantation; transmedics.