Short-Term Outcomes of Heart Transplant From Donor After Circulatory Death

Early outcomes appear favorable for heart transplants (HT) using donation after circulatory death (DCD) organs, according to study findings published in the Journal of the American College of Cardiology.

Researchers analyzed patient records from the Organ Procurement and Transplant Network, managed by the United Network for Organ Sharing (UNOS). Adult DCD donors (n= 3611) between 2020 and February 2021 were assessed for characteristics and whether or not their hearts were used for transplant. Patients (n=3088) who received a transplant from DCD or donation after brain death (DBD) donors during the study period were assessed for outcomes through July 2021.

All DCD donors had a median age of 46 (IQR, 35-56) years; 33.7% were women; 77.85% were White; 47.94% had blood type O; left ventricular ejection fraction (LVEF) was 60% (IQR, 54%-65%); cause of death was brain anoxia (51.95%); head trauma (21.38%); cerebrovascular accident or stroke (21.32%); and central nervous system or other tumor (5.34%).

The DCD donor organs that were used for HT (n=136) were from donors who were younger, had higher LVEF, lower body mass index (BMI), more had type O blood, fewer were women, had diabetes, hypertension, any coronary artery disease, a history of smoking, or died due to brain anoxia (all P <.001).

DCD-HT (n=127) and DBD-HT (n=2961) recipients had a median age of 54 (IQR, 43-61) and 57 (IQR, 47-64) years; 28.35% and 25.80% were women; BMI was 29.4 (IQR, 25.7-33.5) and 27.5 (IQR, 24.3-31.4); 1.57% and 11.82% had gender mismatch with their donor; and 7.87% and 12.06% a size mismatch, respectively.

Compared with the DBD recipients, the DCD group was younger (P =.015), fewer had gender mismatch (P <.001), were on life support with inotropes (P =.005), more had type O blood (P <.001), they had more advanced UNOS status (P <.001), and higher BMI (P <.001).

Among a propensity-matched subset (DCD-HT: n=126; DBD-HT: n=252), the 30-day mortality was 0.8% for DCD-HT and 3.3% for DBD-HT (adjusted hazard ratio [aHR], 0.14; 95% CI, 0.02-1.13; P =.069) and 5.4% and 7.6% at 6 months (aHR, 0.49; 95% CI, 0.18-1.32; P =.158), respectively.

In addition, no significant differences were observed for primary graft failure at 30 days (0.00% vs 1.01%; P =.634), stroke before discharge (5.51% vs 3.94%; P =.352), hemodialysis before discharge (16.54% vs 13.52%; P =.354), permanent pacemaker before discharge (0.79% vs 1.87%; P =.729), or post-transplant length of hospital stay (median, 16 vs 16 days; P =.214) for the DCD-HT and DBD-HT recipients, respectively.

This study was limited by its short-term follow-up. Additional study will be needed to determine long-term outcomes of DCD-HT.

“This analysis of the UNOS database suggests favorable early outcomes of adult HT performed with the use of carefully selected DCD donors in the United States,” the study authors wrote. “In addition, we estimate a substantial increase in HT numbers with widespread use and adoption of DCD donors.”

Reference

Madan S, Saeed O, Forest SJ, Goldstein DJ, Jorde UP, Patel SR. Feasibility and potential impact of heart transplantation from adult donors after circulatory death. J Am Coll Cardiol. Published online December 15, 2021. doi:10.1016/j.jacc.2021.10.042