C356 - DCD-NRP A Valid Approach to Increase Pediatric Donation: The World's First Report of a Combined Liver-Pancreas Transplant

View session detail

Author Block: K. Nijhar¹, D. Walls¹, Z. Kon², J. Pederson¹, M. Glading¹, U. Ekong¹, C. Matsumoto¹, J. Chang¹, C. Rumbo¹, N. Yazigi¹, K. Khan¹, G. Gondolesi¹, ¹MedStar Georgetown Transplant Institute, Washington, DC, ²ProCure On-Demand, New York, NY
*Purpose: Wolcott-Rallison syndrome (WRS) is a rare autosomal recessive disorder characterized by neonatal diabetes and acute liver failure. Combined liver-pancreas transplantation offers the potential to address both hepatic failure and insulin dependence. Organ availability and appropriate size matching limits organ usage but previous DCD+NRP use for multivisceral grafts encouraged us to consider a similar approach for this rare disease.
*Methods: To the best of our knowledge, we describe the first pediatric en-bloc liver-pancreas transplantation in the world from a DCD+NRP donor. The donor was 18-months and 10kg. The donor was on NRP circuit for 1 hour 46 minutes. The lactate trended from 8.7 to 5.2 mmol/L. The organs were used for a 7-year-old female recipient with WRS confirmed by a homozygous mutation in EIF2AK3.
*Results: The organs were procured en-bloc using UW. Engraftment was done by triangulating the upper cava, performing an end-to-end donor portal to recipient SMV anastomosis. An infrarenal aortic conduit was built for arterial reconstruction and a donor to recipient jejunojejunostomy was performed. The cold ischemia time was 7.5 hours. Insulin was discontinued in the OR and GI function recovered by post-op day 4. Doppler ultrasound confirmed patency of the vessels. Immunosuppression was maintained with tacrolimus, MMF, steroids and Jakafi. She was discharged home on post-op day 15.
*Conclusions: This case highlights the feasibility of performing pediatric transplants from pediatric DCD+NRP donors. It also highlights the relevance of adding DCD+NRP as a strategy to increase pediatric donation and transplantation, minimizing mortality on the waiting list.