Heart transplantation using donation after circulatory death in the United States

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 165; no. 5; pp. 1849 - 1860.e6
• Main Authors: Chen, Qiudong, Emerson, Dominic, Megna, Dominick, Osho, Asishana, Roach, Amy, Chan, Joshua, Rowe, Georgina, Gill, George, Esmailian, Fardad, Chikwe, Joanna, Egorova, Natalia, Kirklin, James K., Kobashigawa, Jon, Catarino, Pedro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023
• Subjects: Adult; Brain Death; Cardiovascular System; direct procurement and perfusion; donation after circulatory death; Graft Survival; Heart Transplantation; Heart-Lung Transplantation; Humans; normothermic regional perfusion; organ donation; Retrospective Studies; Tissue and Organ Procurement; Tissue Donors; United States; United States; DCD; heart transplantation; DPP; CI; DBD; IQR; organ donation; NRP; donation after circulatory death; normothermic regional perfusion; UNOS; direct procurement and perfusion; OCS
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2022.05.005

Heart donation after circulatory death was recently reintroduced in the United States with hopes of increasing donor heart availability. We examined its national use and outcomes. The United Network for Organ Sharing database was used to identify validated adult patients undergoing heart transplantation using donation after circulatory death donors (n = 266) and donation after brain death donors (n = 5998) between December 1, 2019, and December 31, 2021, after excluding heart-lung transplants. Propensity score matching was used to create more balanced groups for comparison. The monthly percentage of donation after circulatory death heart transplant increased from 2.5% in December 2019 to 6.8% in December 2021 (P < .001). Twenty-two centers performed donation after circulatory death heart transplants, ranging from 1 to 75 transplants per center. Four centers performed 70% of the national volume. Recipients of donation after circulatory death hearts were more likely to be clinically stable (80.4% vs 41.1% in status 3-6, P < .001), to have type O blood (58.3% vs 39.9%, P < .001), and to wait longer after listing (55, interquartile range, 15-180 days vs 32, interquartile range, 9-160 days, P = .003). Six-month survival was 92.1% (95% confidence interval, 91.3-92.8) after donation after brain death heart transplants and 92.6% (95% confidence interval, 88.1-95.4) after donation after circulatory death heart transplants (hazard ratio, 0.94, 95% confidence interval, 0.57-1.54, P = .79). Outcomes in propensity-matched patients were similar except for higher rates of treated acute rejection in donation after circulatory death transplants before discharge (14.4% vs 8.8%, P = .01). In donation after circulatory death heart recipients, outcomes did not differ based on the procurement technique (normothermic regional perfusion vs direct procurement and perfusion). Heart transplantation with donation after circulatory death donors has short-term survival comparable to donation after brain death transplants. Broader implementation could substantially increase donor organ availability. Outcomes of DCD heart transplantation. [Display omitted]