Long‐Distance Heart Transplantation With Ex Vivo Preservation Systems in a Pediatric Center: An Early Case Series

ABSTRACT Background With the advent of ex vivo preservation systems, donor hearts are now able to be continuously perfused in normothermic conditions with close metabolic monitoring. These capabilities have allowed for significantly longer transport times and thereby increased the donor pool for heart transplant candidates. Although this technology has been rapidly adopted in the adult population, studies in the pediatric population remain rare. Methods This is a retrospective review of an early institutional case series of patients who underwent orthotopic heart transplantation at a pediatric center with a brain‐dead donor organ transported via ex vivo preservation system from November 2022 to January 2024. Study outcomes included death, reintervention, hospital length of stay, and need for post‐operative extracorporeal membrane oxygenator. Results At mean age 16.7 ± 5.9 years, four patients underwent orthotopic heart transplantation via ex vivo preservation system‐mediated procurement. Average distance of procurement was 1551 ± 291 miles. Average time of perfusion on ex vivo preservation system was 362 ± 52 min. Average cold‐ischemic time was 73 ± 26 min. Arterial and venous lactate values at the end of perfusion were less than 5 mmol/L for all patients (mean 2.9 ± 1.4). Primary diagnoses were dilated cardiomyopathy ( n = 2), hypertrophic cardiomyopathy ( n = 1), and hypoplastic left heart syndrome ( n = 1). One patient was on extracorporeal membrane oxygenator at time of transplant due to end‐organ hypoperfusion refractory to medical management. With median follow‐up time of 160 (IQR 95.5, 231) days, there were no deaths or reinterventions. One patient required temporary post‐operative utilization of extracorporeal membrane oxygenator in the setting of primary graft dysfunction for 3 days. Median hospital length of stay was 15.0 days (IQR 13.8, 27). Conclusions Short‐term outcomes for ex vivo preservation system‐mediated heart transplantation in the pediatric population appear acceptable even in the face of significantly longer procurement distances and travel times.