Infant heart transplantation with extremely oversized donor heart: is the donor-recipient size matching too...

Area of Science:

• Pediatric Cardiology
• Transplant Surgery
• Congenital Heart Disease

Background:

• Heart transplantation (HTx) is the primary treatment for pediatric end-stage heart failure.
• Donor availability limits HTx, with donor-recipient weight ratio (DRWR) typically between 0.8-2.5.
• Limited data exists for HTx with DRWR exceeding 3.0.

Observation:

• A 66-day-old infant weighing 3 kg with complex congenital heart disease and severe heart failure underwent HTx.
• The donor was a 4-year-old girl weighing 19.5 kg, resulting in a DRWR of 6.5.
• The infant required phased delayed sternal closure, extracorporeal membrane oxygenation, peritoneal dialysis, and mechanical ventilation.

Findings:

• The infant patient achieved successful discharge after managing post-operative complications.
• The patient remained in optimal condition one year after the heart transplant.
• The complex procedure demonstrated feasibility despite the significantly high DRWR.

Implications:

• Extending the acceptable donor-recipient weight ratio (DRWR) range could significantly expand the donor pool for pediatric heart transplantation.
• This approach may reduce waiting times for children with end-stage heart failure awaiting a life-saving transplant.
• Further research into expanded DRWR criteria could improve outcomes for infants with congenital heart disease.