Perioperative management and short-term outcomes of 12 patients of pediatric heart transplantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xianghong ¹ , ZHANG Qiannan ¹ , FAN Xiangming ² , LIN Ru ³ , YING Liyang ² , YE Lifen ³ , XU Fengli ¹ ,  SHI Shanshan ¹ ,  SHU Qiang ²

1. CICU, Heart Center, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310005, P. R. China;
2. Department of Cardiac Surgery, Heart Center, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310005, P. R. China;
3. Department of Mechanical Circulatory Support for Heart Failure, Heart Center, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310005, P. R. China;

Corresponding?author：

SHI Shanshan, Email: sicu1@zju.edu.cn; SHU Qiang, Email: shuqiang@zju.edu.cn

Keywords：

Pediatric heart transplantation; cardiomyopathy; mechanical circulatory support; bridging to transplantation; postoperative complications; acute kidney injury; immunosuppression; short-term outcome

DOI：

10.7507/1007-4848.202511027

Video：

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Objective To provide a practical reference for optimizing pediatric heart transplantation protocols in China by summarizing the perioperative management and short-term outcomes of pediatric heart transplant recipients at our center. Methods We retrospectively analyzed the medical records of all pediatric heart transplant patients performed at the Heart Center of the Children's Hospital, Zhejiang University School of Medicine, between June 2023 and September 2025. Data on donor and recipient demographics, indications for transplantation, use of mechanical circulatory support (MCS) as a bridge to transplant, perioperative clinical parameters, postoperative complications, immunosuppressive regimens, and follow-up outcomes were collected and analyzed. Results A total of 12 pediatric patients were enrolled, including 5 females and 7 males, with a median age of 9.7 (7.0, 13.0) years, all diagnosed with cardiomyopathy. MCS was used as a bridge to transplant in 58.33% of patients, including extracorporeal membrane oxygenation in 41.67% and a left ventricular assist device in 16.67%. The median donor heart cold ischemic time was 355 (306, 376) minutes. The most common postoperative complications were acute kidney injury (58.3%) and infection (58.3%). One week postoperatively, the median left ventricular ejection fraction recovered to 67.2% (61.8%, 71.0%). At discharge, 10 patients were in New York Heart Association (NYHA) functional class Ⅰ and 2 patients were in class Ⅱ. Over a follow-up period of 1 to 27 months, all patients survived with good cardiac function. Conclusion Our single-center experience demonstrates satisfactory short-term survival and cardiac function recovery in pediatric heart transplantation. Key areas requiring optimization include strategies for MCS bridging, management of prolonged donor heart cold ischemic time, and individualization of immunosuppressive regimens. Future development of a multi-center registry and genomics-guided precise immunosuppression strategies holds the potential to further improve long-term outcomes.

1.	Kirk R, Dipchand AI, Rosenthal DN, et al. The International Society for Heart and Lung Transplantation guidelines for the management of pediatric heart failure: executive summary. J Heart Lung Transplant, 2014, 33(9): 888-909.
2.	Dipchand AI, Kirk R, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: sixteenth official pediatric heart transplantation report-2013; focus theme: age. J Heart Lung Transplant, 2013, 32(10): 979-988.
3.	劉子康, 喬韡華, 王寅, 等. 中國兒童心臟移植現狀與思考. 實用器官移植電子雜志, 2023, 11(3): 202-205.Liu ZK, Qiao WH, Wang Y, et al. Current status and reflections on pediatric heart transplantation in China. Pract J Organ Transplant (Electron Ed), 2023, 11(3): 202-205.
4.	Nilsson J, Jernryd V, Qin G, et al. A nonrandomized open-label phase 2 trial of nonischemic heart preservation for human heart transplantation. Nat Commun, 2020, 11(1): 2976.
5.	Krishnan A, Kasinpila P, Wang H, et al. First-in-human beating-heart transplant. JTCVS Tech, 2023, 19: 80-85.
6.	國家衛生健康委員會. 關于印發中國人體器官分配與共享基本原則和核心政策的通知. 中華人民共和國國家衛生健康委員會公報, 2018, (7): 11-24.National Health Commission of the People's Republic of China. Circular of issuing basic principles and core policies for the distribution and sharing of human organs of China. Gazette Natl Health Comm PRC, 2018, (7): 11-24.
7.	中華人民共和國國家衛生和計劃生育委員會. 人體捐獻器官獲取與分配管理規定(試行). 器官移植, 2016, 7(2): 163-164.National Health and Family Planning Commission of the People's Republic of China. Management regulations on the acquisition and distribution of donated human organs (trial). Organ Transplant, 2016, 7(2): 163-164.
8.	衣慧, 闞福泉, 王輝, 等. 17例兒童心臟移植早期臨床結果分析. 中國胸心血管外科臨床雜志, 2025, 32(9): 1289-1294.Yi H, Kan FQ, Wang H, et al. Analysis of early clinical results in 17 children with heart transplantation. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(9): 1289-1294.
9.	中國醫師協會器官移植醫師分會, 中華醫學會器官移植學分會, 中華醫學會外科學分會移植學組, 等. 中國心臟死亡捐獻器官評估與應用專家共識(2022版). 中華移植雜志 (電子版), 2022, 16(6): 321-328.Organ Transplantation Physician Branch of Chinese Medical Doctor Association, Organ Transplantation Branch of Chinese Medical Association, Transplantation Group of Surgery Branch of Chinese Medical Association, et al. Chinese expert consensus on evaluation and application of donated organs after cardiac death (2022 edition). Chin J Transplant (Electron Ed), 2022, 16(6): 321-328.
10.	中華醫學會器官移植學分會. 中國兒童心臟移植操作規范(2019版). 中華移植雜志 (電子版), 2020, 14(3): 136-142.Branch of Organ Transplantation of Chinese Medical Association. Technical specification for pediatric heart transplantation in China (2019 edition). Chin J Transplant (Electron Ed), 2020, 14(3): 136-142.
11.	Webber SA, McCurry K, Zeevi A. Heart and lung transplantation in children. Lancet, 2006, 368(9529): 53-69.
12.	Nesseler N, Mansour A, Cholley B, et al. Perioperative management of heart transplantation: a clinical review. Anesthesiology, 2023, 139(4): 493-510.
13.	Thongprayoon C, Lertjitbanjong P, Hansrivijit P, et al. Acute kidney injury in patients undergoing cardiac transplantation: a meta-analysis. Medicines (Basel), 2019, 6(4): 108.
14.	Shoji S, Kuno T, Kohsaka S, et al. Incidence and long-term outcome of heart transplantation patients who develop postoperative renal failure requiring dialysis. J Heart Lung Transplant, 2022, 41(3): 356-364.
15.	Boyle JM, Moualla S, Arrigain S, et al. Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation. Am J Kidney Dis, 2006, 48(5): 787-796.
16.	Luikart H. Pediatric cardiac transplantation: management issues. J Pediatr Nurs, 2001, 16(5): 320-331.
17.	Gazit AZ, Fehr J. Perioperative management of the pediatric cardiac transplantation patient. Curr Treat Options Cardiovasc Med, 2011, 13(5): 425-443.
18.	中華醫學會器官移植學分會. 中國心臟移植免疫抑制治療及排斥反應診療規范(2019版). 中華移植雜志 (電子版), 2019, 13(1): 15-20.Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for immunosuppressive therapy and rejection of heart transplantation in China (2019 edition). Chin J Transplant (Electron Ed), 2019, 13(1): 15-20.
19.	陳文倩, 張雷, 張弋, 等. 實體器官移植他克莫司個體化治療專家共識. 實用器官移植電子雜志, 2022, 10(4): 301-308.Chen WQ, Zhang L, Zhang Y, et al. Expert consensus on individualized tacrolimus therapy in solid organ transplantation. Pract J Organ Transplant (Electron Ed), 2022, 10(4): 301-308.
20.	Orgun A, Erdogan I, Varan B, et al. Neurologic complications after pediatric heart transplant: a single-center experience. Exp Clin Transplant, 2022, 20(2): 173-179.
21.	Van Driest SL, Webber SA. Pharmacogenomics: personalizing pediatric heart transplantation. Circulation, 2015, 131(5): 503-512.

1. Kirk R, Dipchand AI, Rosenthal DN, et al. The International Society for Heart and Lung Transplantation guidelines for the management of pediatric heart failure: executive summary. J Heart Lung Transplant, 2014, 33(9): 888-909.
2. Dipchand AI, Kirk R, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: sixteenth official pediatric heart transplantation report-2013; focus theme: age. J Heart Lung Transplant, 2013, 32(10): 979-988.
3. 劉子康, 喬韡華, 王寅, 等. 中國兒童心臟移植現狀與思考. 實用器官移植電子雜志, 2023, 11(3): 202-205.Liu ZK, Qiao WH, Wang Y, et al. Current status and reflections on pediatric heart transplantation in China. Pract J Organ Transplant (Electron Ed), 2023, 11(3): 202-205.
4. Nilsson J, Jernryd V, Qin G, et al. A nonrandomized open-label phase 2 trial of nonischemic heart preservation for human heart transplantation. Nat Commun, 2020, 11(1): 2976.
5. Krishnan A, Kasinpila P, Wang H, et al. First-in-human beating-heart transplant. JTCVS Tech, 2023, 19: 80-85.
6. 國家衛生健康委員會. 關于印發中國人體器官分配與共享基本原則和核心政策的通知. 中華人民共和國國家衛生健康委員會公報, 2018, (7): 11-24.National Health Commission of the People's Republic of China. Circular of issuing basic principles and core policies for the distribution and sharing of human organs of China. Gazette Natl Health Comm PRC, 2018, (7): 11-24.
7. 中華人民共和國國家衛生和計劃生育委員會. 人體捐獻器官獲取與分配管理規定(試行). 器官移植, 2016, 7(2): 163-164.National Health and Family Planning Commission of the People's Republic of China. Management regulations on the acquisition and distribution of donated human organs (trial). Organ Transplant, 2016, 7(2): 163-164.
8. 衣慧, 闞福泉, 王輝, 等. 17例兒童心臟移植早期臨床結果分析. 中國胸心血管外科臨床雜志, 2025, 32(9): 1289-1294.Yi H, Kan FQ, Wang H, et al. Analysis of early clinical results in 17 children with heart transplantation. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(9): 1289-1294.
9. 中國醫師協會器官移植醫師分會, 中華醫學會器官移植學分會, 中華醫學會外科學分會移植學組, 等. 中國心臟死亡捐獻器官評估與應用專家共識(2022版). 中華移植雜志 (電子版), 2022, 16(6): 321-328.Organ Transplantation Physician Branch of Chinese Medical Doctor Association, Organ Transplantation Branch of Chinese Medical Association, Transplantation Group of Surgery Branch of Chinese Medical Association, et al. Chinese expert consensus on evaluation and application of donated organs after cardiac death (2022 edition). Chin J Transplant (Electron Ed), 2022, 16(6): 321-328.
10. 中華醫學會器官移植學分會. 中國兒童心臟移植操作規范(2019版). 中華移植雜志 (電子版), 2020, 14(3): 136-142.Branch of Organ Transplantation of Chinese Medical Association. Technical specification for pediatric heart transplantation in China (2019 edition). Chin J Transplant (Electron Ed), 2020, 14(3): 136-142.
11. Webber SA, McCurry K, Zeevi A. Heart and lung transplantation in children. Lancet, 2006, 368(9529): 53-69.
12. Nesseler N, Mansour A, Cholley B, et al. Perioperative management of heart transplantation: a clinical review. Anesthesiology, 2023, 139(4): 493-510.
13. Thongprayoon C, Lertjitbanjong P, Hansrivijit P, et al. Acute kidney injury in patients undergoing cardiac transplantation: a meta-analysis. Medicines (Basel), 2019, 6(4): 108.
14. Shoji S, Kuno T, Kohsaka S, et al. Incidence and long-term outcome of heart transplantation patients who develop postoperative renal failure requiring dialysis. J Heart Lung Transplant, 2022, 41(3): 356-364.
15. Boyle JM, Moualla S, Arrigain S, et al. Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation. Am J Kidney Dis, 2006, 48(5): 787-796.
16. Luikart H. Pediatric cardiac transplantation: management issues. J Pediatr Nurs, 2001, 16(5): 320-331.
17. Gazit AZ, Fehr J. Perioperative management of the pediatric cardiac transplantation patient. Curr Treat Options Cardiovasc Med, 2011, 13(5): 425-443.
18. 中華醫學會器官移植學分會. 中國心臟移植免疫抑制治療及排斥反應診療規范(2019版). 中華移植雜志 (電子版), 2019, 13(1): 15-20.Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for immunosuppressive therapy and rejection of heart transplantation in China (2019 edition). Chin J Transplant (Electron Ed), 2019, 13(1): 15-20.
19. 陳文倩, 張雷, 張弋, 等. 實體器官移植他克莫司個體化治療專家共識. 實用器官移植電子雜志, 2022, 10(4): 301-308.Chen WQ, Zhang L, Zhang Y, et al. Expert consensus on individualized tacrolimus therapy in solid organ transplantation. Pract J Organ Transplant (Electron Ed), 2022, 10(4): 301-308.
20. Orgun A, Erdogan I, Varan B, et al. Neurologic complications after pediatric heart transplant: a single-center experience. Exp Clin Transplant, 2022, 20(2): 173-179.
21. Van Driest SL, Webber SA. Pharmacogenomics: personalizing pediatric heart transplantation. Circulation, 2015, 131(5): 503-512.

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