A groundbreaking donor heart recovery technique developed at Vanderbilt Health has been successfully adapted for children by pediatric heart transplant surgeons at Monroe Carell Jr. Children's Hospital at Vanderbilt, potentially expanding access to lifesaving heart transplants for children.
In a recent New England Journal of Medicine article, surgeons with the Golisano Pediatric Heart Institute at Monroe Carell and Vanderbilt Health's adult heart transplant team reported on their successful recovery and transplantation of five donor hearts in children using the novel technique known as REUP (rapid recovery with extended ultraoxygenated preservation). Since then, five more children were saved successfully using this novel approach.
"REUP has already helped expand the donor pool for adult heart transplantation, allowing us to transplant more patients, recover hearts from greater distances, and achieve excellent outcomes," said Aaron Williams, MD, Assistant Professor of Cardiac Surgery at Vanderbilt Health and first author of the NEJM article. "By adapting the technique for children, we've been able to recover donor hearts across all pediatric age groups, including hearts that otherwise would not have been used, creating a new opportunity to shorten wait times and save more young lives."
The REUP method was originally developed by Vanderbilt Health's adult heart transplant team for hearts donated after circulatory death (DCD). Unlike existing recovery methods that reanimate the donor heart, REUP preserves the heart by flushing it with a cold oxygen-rich solution after death.
Prior to REUP, the existing approaches for DCD required reanimating the donor heart either inside the donor's body or on specialized perfusion devices. Those methods can raise ethical concerns in some settings and may be expensive, complex or limited by patient size.
Children waiting for a heart transplant can wait many months, particularly among neonates and infants, and long wait times are associated with about 20% waitlist mortality. More than 2,000 children are on the waitlist each year. REUP potentially expands access to donor hearts.
In the NEJM article, the team reported on its successful recovery and transplantation of five donor hearts in children ranging in age from 2 days to 14 years old.
The recipients waited an average of 20 days for transplantation. No donor hearts were discarded, and all recipients demonstrated strong heart function after surgery. None required mechanical circulatory support following transplantation, experienced primary graft dysfunction, or showed evidence of rejection during the study period, the authors noted.
"This innovative approach is truly transformative for the field of pediatric heart transplantation," said Ziv Beckerman, MD, Associate Chief of Pediatric Cardiac Surgery, Surgical Director of Pediatric Heart Transplantation in the Golisano Pediatric Heart Institute at Monroe Carell, and senior author of the NEJM article. "Having the ability to expand the organ donor pool and utilize hearts that would otherwise be discarded is a true blessing for our patients. We are planning on helping other programs advance and adopt this technique to hopefully allow saving many more lives."
The pediatric program's early success builds on previous Vanderbilt Health findings demonstrating the effectiveness of REUP in adults. Those studies showed donor hearts could be safely recovered and preserved without reanimation before transplantation, potentially making more donor hearts available for patients in need.
Additionally, all donor recoveries included in the pediatric study occurred in settings where donor heart reanimation was not permitted because of ethical concerns. Investigators noted that without REUP, these hearts would not have been available for transplantation.
The other Vanderbilt Health and Monroe Carell authors on the paper were: Swaroop Bommareddi, MD; Kevin McGann, MD; Awab Ahmad, MBBS; John Trahanas, MD; Brian Lima, MD; Tammy Ruth, MD; David Bearl, MD; Rachel Harris, DO; Ryan Byrne, MD; Caroline West, MD, MS; A. Joey Lepore, CCP; Phyllis Aycock, CCP; Nicole Michaud, CCP; Sonya Burrell, CCP; Susana Stripling, CCP; Amir Dereshgi, MD; Garrett Coyan, MD, MS; David Bichell, MD; Amanpreet Kalsi, MBBS; Amy Babb, MD; Michael Kuntz, MD; Jessica Clark, DO; Shelley Scholl, RN; Matthew Bacchetta, MD, MBA; Ashish Shah, MD; Yishay Orr, MBBS, PhD; and Carlos Mery, MD, MPH.
