Five-year experience of heart transplantation following donation after circulatory death.

OBJECTIVE: The United States' experience with heart transplantation following donation after circulatory death (DCD HT) has expanded since clinical adoption in 2019. We aimed to examine a large institution's outcomes associated with DCD HT versus HT following donation after brain death (DBD). METHODS: Adult heart recipients and corresponding donors at a single quaternary academic center from January 2019 to October 2024 were included. Recipient and donor data were extracted from the institution's electronic medical record and the United Network for Organ Sharing registry, respectively. The primary outcome was overall survival. RESULTS: In total, 553 heart donors and recipients met inclusion criteria, including 404 (73%) DBD and 149 (27%) DCD recipients. Recipients of DCD allografts were less likely to have an intra-aortic balloon pump before transplant, but there was no significant difference in waitlist status at the time of transplant between the 2 groups. DCD allografts had increased total ischemic time (defined by United Network for Organ Sharing registry as time between donor explant and re-perfusion in the recipient) (5.7 vs 3.7 hours; P < .001) and distance to travel (381 vs 299 miles; P = .001) compared with DBD allografts. Unadjusted Kaplan-Meier survival analysis demonstrated no significant difference between DCD and DBD recipients' cumulative survival (log-rank P = .14). The rate of severe primary graft dysfunction was not significantly different between groups (12% DCD vs 11% DBD; P = .65). CONCLUSIONS: Cardiac allografts from DCD donors perform similarly to a contemporary population of DBD allografts. The rate of severe primary graft dysfunction and the unadjusted cumulative survival were not significantly different between DCD and DBD cohorts.

Duke Scholars

Author Abigail Benkert  

Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery

Author Jacob Niall Schroder Surgery, Cardiovascular and Thoracic Surgery

Author Jeffrey Keenan Surgery, Cardiovascular and Thoracic Surgery