Pediatric Liver Transplantation Following Donation After Circulatory Death Using Normothermic Regional Perfusion: A Novel Application

BACKGROUND: Normothermic regional perfusion (NRP) has transformed donation after circulatory death (DCD) liver transplantation (LT) in adult recipients, achieving outcomes comparable to donation after brain death (DBD). However, its application in pediatric LT remains underexplored. METHODS: We report a case of a pediatric LT using a DCD liver graft recovered with thoracoabdominal NRP (TA-NRP), performed in a 15-year-old female with fulminant hepatic failure secondary to acetaminophen overdose. The graft was recovered from a 45-year-old female donor. CASE DESCRIPTION: Total donor warm ischemia, functional donor warm ischemia, and recipient warm ischemia were 65, 60, and 26 min, respectively. Cold ischemia time was 298 min, and TA-NRP was performed for 130 min. After standard hepatectomy and piggyback implantation, the graft demonstrated immediate and sustained function, and the recipient was discharged from the surgical unit on postoperative day 23. At 18 months of follow-up, graft function remains excellent with no graft-related complications, episodes of rejection, or hospital readmissions. CONCLUSIONS: This case demonstrates the feasibility of pediatric LT using DCD-NRP and supports further evaluation of NRP to expand the donor pool.