A. L. Zhou1, A. Leng1, J. M. Ruck1, A. F. Akbar1, N. M. Desai1, E. A. King1 1Johns Hopkins University School Of Medicine, Department Of Surgery, Baltimore, MD, USA
Introduction: Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a multiorgan procurement technique for donation after circulatory death (DCD) donors. We present the first report of abdominal transplant outcomes of TA-NRP in pediatric donors and recipients in the United States.
Methods: Pediatric DCD liver and kidney donors between 1/1/2020 and 6/30/2023 in the United Network for Organ Sharing database were included. Transplants were stratified based on procurement strategy into TA-NRP and direct recovery. Delayed graft function was compared between TA-NRP and direct recovery transplants using Chi squared tests. Hospital length of stay was assessed using rank sum tests. Survival and all-cause graft failure at 180 days post-transplant were assessed using time-to-event analyses.
Results: A total of 18 pediatric TA-NRP donors donated to 29 kidney and 13 liver recipients. Pediatric TA-NRP donors had higher median age (16 [8-16] vs. 10 [1-14] years, p=0.02) and were more likely to be male (94.4% vs. 58.1%, p=0.002), but had similar time between withdrawal of life support and asystole (23 [15-28] vs. 18 [13-25] minutes, p=0.13) and agonal time (17 [11-23] vs. 16 [11-22] minutes, p=0.48). Pediatric TA-NRP and direct recovery donors had a similar proportion of donors with at least one kidney transplanted (88.9% vs. 84.1%, p=0.58). However, there was a greater proportion of livers recovered for transplant from pediatric TA-NRP vs. direct recovery donors (72.2% vs. 30.5%, p<0.001), and of those recovered, a trend towards a decreased number of livers discarded (0% vs. 22.6%, p=0.054). Kidney transplants utilizing pediatric TA-NRP donors had lower likelihood of delayed graft function (7.1% vs. 29.1%, p=0.01), but similar length of stay (4 [3-4.5] vs. 4 [3-6] days, p=0.14), 180-day survival (100% vs. 98.0%, log-rank p=0.47), and 180-day all-cause graft failure (0.0% vs. 4.8%, log-rank p=0.26; Figure). Liver transplants utilizing pediatric TA-NRP donors also had similar length of stay (9 [6.5-16.5] vs. 8 [6-13] days, p=0.63), 180-day survival (91.2% vs. 94.0%, log-rank p=0.76) and 180-day all-cause graft failure (8.3% vs. 7.6%, log-rank p=0.94). Only three pediatric kidney recipients received TA-NRP grafts, all of whom have survived to 180 days post-transplant.
Conclusion: Utilization of TA-NRP for pediatric donors has resulted in excellent short-term outcomes, mirroring outcomes from adult TA-NRP donors. DCD allografts procured using the TA-NRP have the potential to be suitable donor grafts for pediatric recipients, but ongoing studies should continue to assess outcomes in this population.
