Listing for Pediatric Donation After Circulatory Death Heart Transplantation Is Associated With Improved Waitlist Outcomes.

Abstract

Background: Advances in procurement techniques have enabled use of hearts obtained via donation after circulatory death (DCD), expanding the donor pool; however, the impact of DCD heart transplant on outcomes in children is not well described. We aim to characterize waitlist survival and outcomes in pediatric heart transplant candidates listed for donation after brain death (DBD) versus DCD hearts.

Methods: The United Network for Organ Sharing database was queried for patients aged <18 years at listing, waitlisted for heart transplant between January 2021 and June 2024. Patients were stratified by listing for DBD exclusively, versus DBD and DCD hearts. Waitlist and posttransplant outcomes were compared using Fine-Gray and Kaplan-Meier analyses.

Results: Of 2449 listed patients, 2353 (96.1%) were listed for DBD hearts exclusively, and 96 (3.9%) for DCD hearts as well. DCD recipient candidates had increased rates of cardiopulmonary support and were more likely to be status 1A. Of DCD recipient candidates, 15 (15.6%) received DCD hearts and 50 (52.1%) received DBD hearts. When controlling for status, extracorporeal membrane oxygenation, blood type, region, and year, DCD listing was not associated with likelihood of transplant or waitlist death. Among status 1B/2 patients, DCD listing was associated with increased likelihood of transplant (adjusted subhazard ratio, 2.05 [95% CI, 1.16-3.62]; P=0.01). No patients in the status 1B/2 DCD subgroup died while waitlisted. There were no differences in 1-year posttransplant survival.

Conclusions: Among candidates for pediatric heart transplant listed as status 1B/2, patients listed for DCD hearts in addition to DBD hearts have shorter waitlist duration, improved transplant rates, lower waitlist mortality rates, and comparable survival to patients listed for DBD hearts alone.