Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Donation after circulatory death (DCD) heart transplantation has expanded rapidly in adults but remains limited compared with traditional donation after brain death (DBD) in pediatric practice as a result of technical, logistical, and ethical challenges. Therefore, we sought to evaluate early outcomes of DCD and DBD pediatric heart transplantation by using a contemporary national cohort. Methods 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 who underwent heart transplantation after January 1, 2024, was analyzed separately. Candidate, donor, and perioperative characteristics were compared, whereas posttransplant survival was estimated using Kaplan-Meier analysis. Results Among 8359 pediatric heart transplant recipients during the study period, 52 received DCD allografts. DCD recipients were younger (7 years vs 4 years; P < .001) but otherwise similar to DBD recipients. DCD donors were also younger (9 years vs 6 years; P = .02) and more likely to be size mismatched (12% vs 21%; P = .06), although donor-recipient distance was greater (335 miles vs 429 miles; P = .01). Perioperative outcomes were largely similar across groups. Kaplan-Meier 3-year survival (87% vs 87%; P = .65) and contemporary 1-year survival (100% vs 92%; P = .24) were similar across groups. Conclusions Pediatric heart transplantation using DCD donors achieves early survival comparable to that of 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.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $975
OpenAlex ID: W7201832841