title: Pediatric heart transplantation after declaration of cardiocirculatory death.
abstract: In three infants awaiting orthotopic cardiac transplantation, transplantation was successfully performed with the use of organs from donors who had died from cardiocirculatory causes. The three recipients had blood group O and were in the highest-risk waiting-list category. The mean age of donors was 3.7 days, and the mean time to death after withdrawal from life support was 18.3 minutes. The 6-month survival rate was 100% for the 3 transplant recipients and 84% for 17 control infants who received transplants procured through standard organ donation. The mean number of rejection episodes among the three infants during the first 6 months after surgery was 0.3 per patient, as compared with 0.4 per patient among the controls. Echocardiographic measures of ventricular size and function at 6 months were similar among the three infants and the controls (left ventricular shortening fraction, 43.6% and 44.9%, respectively; P=0.73). No late deaths (within 3.5 years) have occurred in the three infants, and they have had functional and immunologic outcomes similar to those of controls. Mortality while awaiting a transplant is an order of magnitude higher in infants than in adults, and donors who died from cardiocirculatory causes offer an opportunity to decrease this waiting-list mortality.
authors.affiliation: Department of Pediatrics, Joe DiMaggio Children's Hospital, Hollywood, FL 33021, USA. mboucek@mhs.net
authors.forename: Mark M
authors.initials: MM
authors.lastname: Boucek
authors.forename: Christine
authors.initials: C
authors.lastname: Mashburn
authors.forename: Susan M
authors.initials: SM
authors.lastname: Dunn
authors.forename: Rebecca
authors.initials: R
authors.lastname: Frizell
authors.forename: Leah
authors.initials: L
authors.lastname: Edwards
authors.forename: Biagio
authors.initials: B
authors.lastname: Pietra
authors.forename: David
authors.initials: D
authors.lastname: Campbell
mesh_terms: D001926:Brain Death; D003643:Death; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006323:Heart Arrest; D006330:Heart Defects, Congenital / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D015996:Survival Rate; D020458:Third-Party Consent; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome