There are no significant differences in 1-year mortality, survival to hospital discharge, severe primary graft dysfunction (PGD), and other outcomes post heart transplant between patients who receive a heart obtained by donation after circulatory death (DCD) and patients who receive a heart by donation after brain death (DBD), a new study has shown.
The retrospective review included 385 patients (median age, 57.4 years; 26% women; 72.5% White patients) who underwent a heart transplant at Vanderbilt University Medical Center from January 2020 to January 2023. Of these, 263 received DBD hearts, and 122 received DCD hearts.
In the DCD group, 17% of hearts were recovered by use of ex vivo machine perfusion (EVP), and 83% by use of normothermic regional perfusion followed by static cold storage; 4% of DBD hearts were recovered by use of EVP, and 96% by use of static cold storage.
The primary outcome was survival at 1 year after transplantation; key secondary outcomes included survival to hospital discharge, survival at 30 days and 6 months after transplantation, and severe PGD.
There was no difference in 1-year post-transplant survival between DCD (94.3%) and DBD (92.4%) recipients (hazard ratio [HR], 0.77; 95% CI, 0.32 – 1.81; P = .54), a finding that was unchanged when adjusted for recipient age.
There were no significant differences in survival to hospital discharge (93.4% DBD vs 94.5% DCD; HR, 0.72; 95% CI, 0.26 – 1.99; P = .53), to 30 days (95.1% DBD vs 96.7% DCD; HR, 0.67; 95% CI, 0.22 – 2.05; P = .48), or to 6 months (92.8% DBD vs 94.3% DCD; HR, 0.68; 95% CI, 0.25 – 1.85; P = .45) after transplantation.
The incidence of severe PGD was similar between groups (5.7% DCD vs 5.7% DBD; HR, 1.00; 95% CI, 0.41 – 2.4; P = .99).
There were no significant between-group differences in other outcomes, including incidence of treated rejection and cases of cardiac allograft vasculopathy of grade 1 or greater on the International Society for Heart and Lung Transplantation scale at 1 year.
“Our findings add to the growing body of evidence in support of DCD heart transplantation,” the authors write, potentially expanding the heart donor pool. They note that outcomes remained similar between groups despite higher-risk patients being overrepresented in the DCD cohort.
In an accompanying editorial, Sean P. Pinney, MD, Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, and a colleague called the results “impressive” and “encouraging,” although there are still “important unknowns,” including longer-term outcomes, the financial impact of DCD, and whether results can be replicated in other centers.
“These results provide confidence that DCD can be safely and effectively performed without compromising outcomes, at least in a large-volume center of excellence,” and help provide evidence “to support the spreading acceptance of DCD among heart transplant programs.”
The study was conducted by Hasan K. Siddiqi, MD, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues. It was published online October 2, 2023, in the Journal of the American College of Cardiology.
The study was conducted at a single center and had a retrospective design and a modest sample size that prevented adjustment for all potentially confounding variables. Meaningful differences among DCD recipients could not be explored with regard to organ recovery technique, and small but statistically meaningful differences in outcomes could not be detected, the authors note. Follow-up was limited to 1 year after transplantation.
The authors report no relevant conflicts of interest. Pinney has received consulting fees from Abbott, ADI, Ancora, CareDx, ImpulseDynamics, Medtronic, Nuwellis, Procyrion, Restore Medical, Transmedics, and Valgen Medtech.
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