Skip to main content
Have a personal or library account? Click to login
Early outcomes of pediatric heart transplantation: Impact of mechanical circulatory support and perioperative challenges. A single-center retrospective study Cover

Early outcomes of pediatric heart transplantation: Impact of mechanical circulatory support and perioperative challenges. A single-center retrospective study

Open Access
|Apr 2026

Figures & Tables

Figure 1.

ICU length of stay (LOS) stratified by pre-transplant support type. Boxplot comparing ICU LOS in patients bridged with extracorporeal membrane oxygenation (ECMO, n = 11) versus ventricular assist devices (VAD: HeartMate 3 and Berlin Heart EXCOR, n = 18). Median ICU LOS was longer in ECMO patients (12 days, IQR 9–16) compared to VAD patients (6 days, IQR 5–9), p = 0.04 (Wilcoxon rank-sum test). Boxes represent the interquartile range, whiskers the range, and horizontal lines the median.

Fig. 2.

Kaplan–Meier 30-day survival after pediatric heart transplantation (n = 30). Kaplan–Meier survival curve demonstrates 30-day survival of 28/30 patients (93.5%, 95% CI 78–99). Two deaths occurred on days 10 and 18. Survival probability remained stable after day 18. Due to only two events, regression analysis was not performed.

Early post-transplant outcomes (30 days)

Variablen (%), median [IQR]
30-day survival, n (%)28 (93.5)
Acute graft rejection, n (%)3 (9)

Rejection
- Cellular rejection, steroids/Tac optimization, n (%)1 (3.3)
- Cellular/Humoral rejection, unspecified, n (%)1 (3.3)
- Humoral rejection, IVIGb/plasmapheresis n (%)1 (3.3)

Infections within 30 days, n (%)4 (13.3)
Acute kidney injury, n (%)8 (26.7)
CRRT, n (%)2 (6.7)
Liver dysfunction, n (%)6 (19.8)
Neurological complications, n (%)3 (10.3)
Post-op ventilation duration, days8 [2–15]
ICU LOS, days20 [11–33]
Hospital LOS, days37 [22–66]

Patient demographics, primary diagnosis, and comorbidities (n=30)

Variablen (%), median [IQR]
Patient Demographics
Age at transplant, years9 [6–12]
Female gender, n (%)19 (63.3)
Male gender, n (%)11 (36.6)
Weight at transplant, kg25.6 [22.3–35.0]

Primary Diagnosis
DCM and related cases
- DCM, n (%)20 (66.7)
CHD and complex defects
- Complex CHD, n (%)5 (16.7)
Other cardiac conditions
- Complete Heart Block on PPM Post Arrest, n (%)1 (3.3)
- Kawasaki Disease with Coronary Abnormalities, n (%)1 (3.3)

VLCAD deficiency, n (%)1 (3.3)
Familial hypercholesterolemia, n (%)2 (6.6)

Intraoperative data and complications_

Variablen (%), median [IQR]
Donor age, years28 [13–36]

Donor gender
- Male, n (%)17 (56.7)
- Female, n (%)13 (43.3)

Ischemic time, minutes260 [202–299]

Intraoperative complications
- Bleeding, n (%)17 (56.7)
- Bleeding + Hypotension, n (%)12 (40.0)
- RV low contractility + Hypotension, n (%)1 (3.3)

ACC time, minutes185 [102–218]
CPB time, minutes231 [206–301]

comparative analysis of the heart transplant after ECMO or VAD support_

VariableECMO (n = 11)VAD (n = 18)
30-day survival10/11 (91%)17/18 (94%)
Acute rejection1 (9%)2 (11%)
Infections2 (18%)2 (11%)
Acute kidney injury (AKI)4 (36%)4 (22%)
CRRT required1 (9%)1 (6%)
Neurological complications2 (18%)1 (6%)
Liver dysfunction2 (18%)4 (22%)
Post-op ventilation (days)12 [9–16]6 [5–9]
ICU LOS (days)24 [18–34]16 [10–24]
Hospital LOS (days)42 [28–66]34 [22–50]

Pre-transplant status and clinical parameters

Variablen (%), median [IQR]
Duration of heart failure, months04 [2–15]

Decompensation status
- Mechanical support, n (%)29 (96.7)
- Inotropic support, n (%)01 (3.3)

Mechanical support type
- ECMO, n (%)11 (36.6)
- HeartMate 3, n (%)08 (26.4)
- Berlin Heart EXCOR, n (%)(33.3)
- Inotropic support only, n (%)01 (3.3)

Duration of mechanical support before transplant, days26 [6–92]
Pre-transplant ventilation, n (%)17 (56.7)
Duration of ventilation, days08 [2–15]
DOI: https://doi.org/10.62838/jccm-2026-0016 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 291 - 299
Submitted on: Oct 21, 2025
Accepted on: Mar 11, 2026
Published on: Apr 30, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Muhammad Shahzad, Reem Beheri, Bushra Algethami, Yasser Alheraish, Dimpna Albert, Felix W Tsai, Zohair Alhalees, Khaled Alarwan, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.