Surgeons at Monroe Carell Jr. Children’s Hospital at Vanderbilt Transplant Ten Donor Hearts Using REUP Technique
Surgeons at Monroe Carell Jr. Children’s Hospital at Vanderbilt have successfully adapted a novel adult donor heart recovery technique for pediatric patients, according to a report published in the New England Journal of Medicine. The approach, known as REUP (rapid recovery with extended ultraoxygenated preservation), allowed transplant teams to recover and successfully transplant ten donor hearts in children ranging from two days to 14 years old.
How REUP Works for Pediatric Heart Transplants
Vanderbilt Health’s adult heart transplant team initially created the REUP approach for hearts gathered following circulatory death, also known as DCD. Traditional recovery methods typically require reanimating the donor heart either inside the donor’s body or on specialized perfusion devices before transplantation. In contrast, REUP preserves the donor heart by flushing it with a cold, oxygen-rich solution immediately after death, bypassing the need for reanimation.
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,
remarked Aaron Williams, MD, Assistant Professor of Cardiac Surgery at Vanderbilt Health, who also served as the primary author for the NEJM publication. 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.
Addressing Pediatric Waitlist Mortality
Children waiting for a heart transplant face long wait times, particularly neonates and infants, which leads to a waitlist mortality rate of about 20%. More than 2,000 children sit on the national heart transplant waitlist each year. In the pediatric cohort reported in the NEJM study, young recipients waited an average of 20 days for transplantation. None of the donor hearts were discarded, and all recipients showed strong heart function following surgery without requiring mechanical circulatory support.
None of the patients experienced primary graft dysfunction or showed evidence of rejection during the study period.
Ziv Beckerman Plans to Expand Pediatric Heart Transplantation Technique
This innovative approach is truly transformative for the field of pediatric heart transplantation,
noted Ziv Beckerman, MD, Associate Chief of Pediatric Cardiac Surgery, Surgical Director of Pediatric Heart Transplantation in the Golisano Pediatric Heart Institute at Monroe Carell, alongside his role as senior author of the NEJM paper. 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.
Frequently Asked Questions About Pediatric REUP Transplants
What does REUP stand for?
REUP stands for rapid recovery with extended ultraoxygenated preservation. It is a preservation technique that flushes a donor heart with a cold, oxygen-rich solution after death instead of reanimating it.
Which patients were included in the Vanderbilt study?
The initial NEJM report covered five pediatric patients ranging in age from 2 days to 14 years old who received donor hearts recovered via REUP. An additional five children have since been saved using the same approach.
Why are DCD hearts often difficult to use in children?
Hearts donated after circulatory death traditionally require reanimation inside the donor or on perfusion devices, which can introduce ethical barriers, high costs, technical complexity, and sizing limitations for small infants.