Ex-vivo allograft perfusion for complex pediatric heart transplant recipients.

Abstract Background Pediatric heart transplant (HTx) recipients with congenital heart defects require complex concomitant surgical procedures with the risk of prolonging the allograft’s ischemic time. Ex- vivo allograft perfusion with the Organ Care System (OCS) may improve survival of these challenging patients. Methods Retrospective, single center study. A consecutive series of 8 children with allografts preserved using the OCS was compared to 13 children after HTx with cold storage of the donor heart from 3/2018 to 3/2020. Results Median recipients age in the control group was 18 (range 1- 189) months vs. 155 (83- 214) months in the OCS group, the baseline differences between the two groups were not significant. 50% of the children in the OCS group had complex congenital heart defects (vs. 15% of the controls). Median operation time during HTx in the OCS group was 616 (270- 809) min vs. 329 (283- 617) min. Due to the time of ex- vivo allograft perfusion (265 (202- 372) minutes) median total ischemia time was significantly shorter in the OCS group 78 (52- 111) vs. 222 (74-326) minutes. The incidence of primary graft failure, renal or hepatic failure did not differ between the groups. Graft function and the occurrence of any treated rejection at follow up revealed no significant difference between the two groups. One-year survival was 88% in the OCS group (vs. 85%). Conclusions Ex-vivo allograft perfusion enabled complex pediatric heart transplantations, yielding outcomes as positive as those of children whose donor hearts were stored in ice-cold solution.