Pediatric transplantation · 2026
Expanding the Donor Pool in Pediatric Transplantations: Successful Domino Liver Transplantation From the Youngest Reported Pediatric DCD Donor Using Normothermic Regional Perfusion in the United States.
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Kahan Anastasia M, van der Schyff Francisca, Contreras Alan G, Peterson Dave N, Jensen M Kyle, Sweney Jill, Troy Lindsey N, Botha Jean F, Kastenberg Zachary J
Аннотация
INTRODUCTION: Normothermic regional perfusion (NRP) during donation after circulatory death (DCD) improves abdominal organ utilization by limiting warm ischemia time. Its application in young pediatric donors remains exceptionally rare; the youngest previously reported DCD-NRP donor in the United States was 5 years of age.
METHODS: We describe DCD-NRP organ procurement from a 23-month-old donor and the subsequent use of the liver graft in a domino liver transplantation involving two pediatric recipients. The kidneys were recovered en bloc. The donor, supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) following hypoxic-ischemic injury, underwent DCD-NRP using the preexisting ECMO cannulation after thoracic exclusion of the cerebral and coronary circulations. The recovered graft was transplanted into a 4-year-old with maple syrup urine disease (MSUD), whose explanted native liver was then used as a domino graft for an 18-month-old with biliary atresia.
RESULTS: NRP was established rapidly with restoration of metabolic activity, and both transplants were technically successful with good early graft function. The MSUD recipient underwent re-laparotomy for a suspected intra-abdominal source of sepsis (no anastomotic leak identified; cultures negative) and recovered with appropriately trending branched-chain amino acid levels, and was discharged on posttransplant Day 17. The domino recipient had an uncomplicated course and was discharged on posttransplant Day 6.
CONCLUSION: To our knowledge, this is the youngest DCD-NRP liver donor reported in the United States and the youngest domino liver transplantation performed using a DCD-NRP graft. Deliberately pairing NRP with domino transplantation may synergistically expand the critically limited pediatric donor pool.
METHODS: We describe DCD-NRP organ procurement from a 23-month-old donor and the subsequent use of the liver graft in a domino liver transplantation involving two pediatric recipients. The kidneys were recovered en bloc. The donor, supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) following hypoxic-ischemic injury, underwent DCD-NRP using the preexisting ECMO cannulation after thoracic exclusion of the cerebral and coronary circulations. The recovered graft was transplanted into a 4-year-old with maple syrup urine disease (MSUD), whose explanted native liver was then used as a domino graft for an 18-month-old with biliary atresia.
RESULTS: NRP was established rapidly with restoration of metabolic activity, and both transplants were technically successful with good early graft function. The MSUD recipient underwent re-laparotomy for a suspected intra-abdominal source of sepsis (no anastomotic leak identified; cultures negative) and recovered with appropriately trending branched-chain amino acid levels, and was discharged on posttransplant Day 17. The domino recipient had an uncomplicated course and was discharged on posttransplant Day 6.
CONCLUSION: To our knowledge, this is the youngest DCD-NRP liver donor reported in the United States and the youngest domino liver transplantation performed using a DCD-NRP graft. Deliberately pairing NRP with domino transplantation may synergistically expand the critically limited pediatric donor pool.