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Updated: Jun 21, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Late donor cardiectomy after paediatric heterotopic cardiac transplantation
V Tsang1, M Yacoub, S Sridharan
1Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK.
Insights
Pediatric heart transplant recipients can experience native heart recovery, allowing donor heart removal and cessation of immunosuppression. This case highlights successful management of a child with post-transplant lymphoproliferative disorder (PTLD) after heterotopic cardiac transplantation.
Area of Science:
- Pediatric Cardiology
- Immunology
- Transplantation Medicine
Background:
- Cardiac transplantation is vital for infants with advanced cardiomyopathy but faces donor shortages and immunosuppression complications like PTLD.
- Heterotopic cardiac transplantation is a complex procedure in infants, often complicated by PTLD.
- This case involves an infant with dilated cardiomyopathy and pulmonary hypertension undergoing heterotopic cardiac transplantation.
Observation:
- An infant developed recurrent PTLD, resistant to standard therapies including immunosuppression reduction.
- The patient's native heart showed remarkable recovery over 10.5 years post-transplant.
- This recovery allowed for the eventual removal of the donor heart and complete cessation of immunosuppression.
Findings:
- Successful management of a challenging case of PTLD in a pediatric heart transplant recipient.
- Demonstrated native heart recovery in a patient following heterotopic cardiac transplantation.
- Complete remission from PTLD and normal cardiac function achieved after donor heart explantation.
Implications:
- Highlights the potential for native heart recovery in pediatric cardiac transplant recipients.
- Offers insights into managing PTLD and optimizing immunosuppression strategies.
- Suggests heterotopic transplantation may offer unique advantages in specific pediatric cases, including potential for native heart recovery.
Background:
Cardiac transplantation is a life-saving procedure in infants and children with advanced cardiomyopathy. However, it is greatly limited by shortage of paediatric donors and the complications of long-term immunosuppression, including post-transplant lymphoproliferative disorder (PTLD). We report the management of an infant who had heterotopic cardiac transplantation for advanced cardiomyopathy with secondary pulmonary hypertension who developed seemingly incurable PTLD.
Methods:
An 8-month-old girl presented in 1994 with signs of severe heart failure, secondary to dilated cardiomyopathy. At age 11 months, the patient underwent a heterotopic cardiac transplantation.
Findings:
The patient developed many episodes of PTLD associated with Epstein-Barr virus infection that were resistant to several therapies, including reduction of immunosuppression. Native heart recovery enabled removal of the donor heart 10.5 years after the original operation to allow complete cessation of immunosuppression. Her postoperative course was uncomplicated and the outcome was excellent. 3.5 years after surgery, the patient remains well, in complete remission from her PTLD, and has normal cardiac function.
Interpretation:
This case shows several issues relating to the use of heterotopic cardiac transplantation in infants and the capacity of the heart to recover. It also provides new insights into the interaction between the immune system with several aspects of modern management of post-transplantation PTLD.
Funding:
None.
