Hearts transplanted after circulatory death in children: Analysis of the International Society for Heart and Lung Transplantation registry

We aimed to describe worldwide DCD HT experience in children using the International Society for Heart and Lung Transplantation Registry. The Registry was queried for primary HT performed in children (2005-2014). Kaplan-Meier analysis was used to assess survival for recipients grouped by DCD or DBD hearts. Recipient characteristics were compared between DCD and DBD and between survivors and non-survivors of DCD HT. Among 3877 pediatric HT performed, 21 (0.5%) were DCD. DCD 1-year survival was 61% vs 91% DBD, P <.01. DCD recipients were more often supported by ECMO pre-HT (24% vs 6%, P <.001) and more often receiving inhaled nitric oxide (10% vs 0.6%, P <.001) compared to DBD. Older DCD recipients had significantly lower 1-year survival of 57% vs 93% for DBD, P <.01. Survival for infant DCD recipients was not statistically different to DBD recipients (survival 62% at 1 year and 62% at 5 years for DCD vs 85% at 1 year and 77% at 5 years for DBD, P =.15). Recipients of DCD HT who died were more often supported by ECMO pre-HT (56% non-survivors vs 0% survivors, P =.004) and receiving mechanical ventilation (44% vs 0%, P =.012). DCD HT is uncommon in children. DCD-independent factors in recipients may have contributed to worse survival as DCD recipients who died were more often supported by ECMO and mechanical ventilation. More research is needed to identify donor factors and recipient factors that contribute to mortality after DCD HT.