Log in to MyACC
Clinical Performance of Hearts Donated After Circulatory Death
Quick Takes
- Donation of circulatory death (DCD) heart recipients had a higher risk of severe primary graft dysfunction in the first 24 hours compared to donation after brain death (DBD) heart recipients, but this risk declined with increased center experience with DCD.
- Hemodynamics suggested worse right ventricular function after DCD transplant in the first 2 weeks, which normalized after.
- DCD recipients had comparable survival, with no increased risk for rejection, with a shorter waitlist time compared to DBD recipients.
Study Questions:
What are the hemodynamic profiles of hearts obtained after donation of circulatory death (DCD) compared with donation after brain death (DBD) donor hearts?
Methods:
This was a retrospective, single-center study that compared outcomes of DCD donor recipients with DBD donor recipients from 2016–2022. All DCD donor hearts were re-animated using the TransMedics Organ Care System (OCS). The organ was explanted and transplanted into a recipient using standard protocols, and post-transplant surveillance was resumed per site protocol.
Results:
DCD heart recipients were younger (55 vs. 59 years) and less likely inpatient at the time of transplant with lower pulmonary vascular resistance. DCD donors were younger (30 vs. 37 years), more likely to be male, and the cause of death was more likely to be head trauma. DCD recipients spent lesser time on the transplant waitlist compared to standard DBD recipients. A total of 47 listed patients received DCD hearts. One-week post-transplant right heart catheterizations (RHCs) showed an elevated right atrial pressure and pulmonary capillary pressure in the DCD group with a lower mean pulmonary artery pulsatility index suggesting worse right ventricular function. After the second RHC, these numbers were similar. Cardiac output did not differ post-transplant between the two groups and median left ventricular ejection fraction on first echo was similar in both groups.
In the DCD group, there was a trend towards increased severe primary graft dysfunction (PGD) at 24 hours. Rates of 2R rejection were no different between the two groups. Post-transplant length of stay, intensive care unit length of stay and readmission, and 30-day readmissions were similar between both groups. With increased DCD transplant experience, incidence of severe PGD at 24 hours declined.
Conclusions:
In a single-center cohort, short-term and long-term survival between DCD and DBD recipients was no different. Risk of severe PGD at 24 hours was higher among DCD recipients but this rate declined with increased center experience. DCD recipients waited for a shorter duration on the heart transplant waitlist.
Perspective:
Cardiac transplant is the only curative option for patients with end-stage heart failure. A shortage of donor organs leads to limited access to transplant, and DCD donation has the potential of increasing the donor pool by 30%. In this study, the transmedics OCS was used for all DCD donations. As expected, DCD recipients spent 17 fewer days on the waitlist than DBD recipients. DCD transplant was associated with worse right ventricular function and a trend towards increased severe PGD in the first 24 hours; however, the hemodynamics after 2 weeks were comparable between groups. Survival between the two groups did not differ, with no difference between rejection rates. Importantly, as the center gained more experience, early PGD rates declined in DCD recipients. These data suggest that DCD heart transplant is a valid and effective option that is likely to expand the donor pool substantially.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and Imaging, Interventions and Vascular Medicine, Echocardiography/Ultrasound
Keywords: Brain Death, Cardiac Catheterization, Craniocerebral Trauma, Echocardiography, Graft Survival, Heart Failure, Heart Transplantation, Hemodynamics, Inpatients, Intensive Care Units, Length of Stay, Patient Readmission, Preimplantation Diagnosis, Primary Graft Dysfunction, Tissue Donors, Vascular Resistance, Ventricular Function, Left, Ventricular Function, Right
< Back to Listings
