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Updated: Jul 23, 2025
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
An integrated program to expand donor utilization in pediatric heart transplantation: Case report of successful
Diana M Torpoco Rivera1, Seth A Hollander1, Christopher Almond1
1Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA.
Insights
Pediatric heart transplantation (HT) can overcome donor limitations using innovative strategies. This case demonstrates successful HT with a Hepatitis C virus positive donor and advanced preservation, expanding options for children needing transplants.
Area of Science:
- Cardiology
- Transplantation Immunology
- Pediatric Critical Care
Background:
- Pediatric heart transplantation (HT) faces challenges including donor organ scarcity and declined offers due to donor risk factors.
- Geographic distance and donor-recipient weight disparities further complicate organ allocation for pediatric patients.
Observation:
- A complex pediatric case involving cardiomyopathy, pulmonary hypertension, and specific medical therapies (milrinone, apixaban) required innovative solutions.
- The use of an extracorporeal heart preservation system (TransMedics™ OCS Heart) facilitated organ transport over extended distances.
Findings:
- Successful pediatric heart transplantation was achieved using a donor heart with multiple risk factors, including Hepatitis C virus (HCV) positivity and an increased donor-to-recipient weight ratio.
- The patient experienced no significant post-operative bleeding and demonstrated normal biventricular function upon discharge on post-operative day 15.
- Post-transplant HCV seroconversion was effectively managed, highlighting the successful integration of strategies to mitigate donor-related risks.
Implications:
- This case underscores the potential of utilizing 'marginal' donors in pediatric heart transplantation through an integrative team approach.
- Implementing advanced donor utilization strategies can expand the limited donor pool, offering more opportunities for children requiring life-saving heart transplants.
- Careful evaluation and management of donors with risk factors are crucial for improving outcomes in pediatric heart recipients.
Background:
Pediatric heart transplantation (HT) continues to be limited by the shortage of donor organs, distance constraints, and the number of potential donor offers that are declined due to the presence of multiple risk factors.
Methods:
We report a case of successful pediatric HT in which multiple risk factors were mitigated through a combination of innovative donor utilization improvement strategies.
Results:
An 11-year-old, 25-kilogram child with cardiomyopathy and pulmonary hypertension, on chronic milrinone therapy and anticoagulated with apixaban, was transplanted with a heart from a Hepatitis C virus positive donor and an increased donor-to-recipient weight ratio. Due to extended geographic distance, an extracorporeal heart preservation system (TransMedics™ OCS Heart) was used for procurement. No significant bleeding was observed post-operatively, and she was discharged by post-operative day 15 with normal biventricular systolic function. Post-transplant Hepatitis C virus seroconversion was successfully treated.
Conclusions:
Heart transplantation in donors with multiple risk factor can be achieved with an integrative team approach and should be taken into consideration when evaluating marginal donors in order to expand the current limited donor pool in pediatric patients.
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