Introduction: The availability of suitable donors for pediatric transplantation remains a major challenge. While multiple studies in adults have demonstrated the success of normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD), data on pediatric recipients remain scarce. Herein, we report our single-center experience with pediatric transplantation using cDCD-NRP organs.
Methods: This retrospective observational study analyzed the outcomes of pediatric patients (aged ˂ 18 years) who underwent liver (LT), multivisceral (MVT), kidney (KT), and heart transplantation (HT) using cDCD-NRP organs between 2021 and 2024.
Results: A total of 42 cDCD-NRP transplants were performed: 10 LT, 3 MVT, 20 KT, and 9 HT. The median days on the waiting list were 30.4 (23.6–58.7) for LT, 273 (107–988) for MVT, 26.3 (11.5–85.6) for KT, and 45 (17–64) for HT. The median functional warm ischemia time (FWIT) was 21.5 min (IQR: 7–30), and the median duration of NRP was 94 min (IQR: 53–191). One-year patient survival rates were 80% for LT, 67.7% for MVT, 100% for KT, and 85.7% for HT. One-year graft survival rates were 70% for LT, 67.7% for MVT, 87.5% for KT, and 83.4% for HT. No cases of ischemic cholangiopathy or vascular complications occurred in the LT group. Among kidney recipients, no cases of delayed graft function were reported, and only one patient experienced primary non-function.
Conclusions: cDCD-NRP provides good-quality grafts for pediatric transplantation. This additional organ source is particularly valuable for reducing waiting list times in pediatric patients.