Implications of Initiating DCD Heart Transplantation at a Single US Center

Purpose Donor organ demand continues to outpace supply in heart transplantation with 3,481 patients on the waiting list as of October 2021. Donors after circulatory death (DCD) are a potential source of additional hearts which can lessen the unmet need in the advanced heart failure population. We sought to define the impact of DCD heart transplantation on recipient waiting time for transplant as well as hemodynamic function of DCD allografts and patient outcomes in relation to standard of care (SOC) recipients. Methods We evaluated hemodynamic profiles and outcomes in recipients of DCD hearts compared to SOC heart recipients at a single United States institution. SOC recipients from April 2016-February 2021 and DCD recipients from November 2019 through February 2021 were included. Recipients of hepatitis-C positive donors hearts and multiorgan transplants were excluded. Primary graft dysfunction was defined based on the International Society of Heart and Lung Transplantation consensus report. Results Median time from DCD consent to transplant was significantly shorter than SOC waiting list time (14 days vs 43 days; P<0.001). Right heart function was significantly impaired in DCD recipients compared to SOC recipients 1-week post-transplant (higher median right atrial pressure, higher RAP/PCWP, and lower pulmonary arterial pulsatility index; all P≤0.05). Thereafter, clinical course and hemodynamic parameters were similar between groups in post-transplant weeks 2-4 (figure 1). Severe primary graft dysfunction was more common with DCD compared to SOC hearts (19% vs 4%; P=0.014). In DCD recipients, 30-day survival was 100% with 1 death over a median of 7 months follow-up, relative to 96.2% 30-day survival and 15 deaths over a median of 30 months follow-up in SOC heart recipients. Conclusion Despite higher rates of transient right heart dysfunction and severe primary graft dysfunction, the use of DCD hearts appears to be feasible, safe, and effective in this initial United States single institution series. Donor organ demand continues to outpace supply in heart transplantation with 3,481 patients on the waiting list as of October 2021. Donors after circulatory death (DCD) are a potential source of additional hearts which can lessen the unmet need in the advanced heart failure population. We sought to define the impact of DCD heart transplantation on recipient waiting time for transplant as well as hemodynamic function of DCD allografts and patient outcomes in relation to standard of care (SOC) recipients. We evaluated hemodynamic profiles and outcomes in recipients of DCD hearts compared to SOC heart recipients at a single United States institution. SOC recipients from April 2016-February 2021 and DCD recipients from November 2019 through February 2021 were included. Recipients of hepatitis-C positive donors hearts and multiorgan transplants were excluded. Primary graft dysfunction was defined based on the International Society of Heart and Lung Transplantation consensus report. Median time from DCD consent to transplant was significantly shorter than SOC waiting list time (14 days vs 43 days; P<0.001). Right heart function was significantly impaired in DCD recipients compared to SOC recipients 1-week post-transplant (higher median right atrial pressure, higher RAP/PCWP, and lower pulmonary arterial pulsatility index; all P≤0.05). Thereafter, clinical course and hemodynamic parameters were similar between groups in post-transplant weeks 2-4 (figure 1). Severe primary graft dysfunction was more common with DCD compared to SOC hearts (19% vs 4%; P=0.014). In DCD recipients, 30-day survival was 100% with 1 death over a median of 7 months follow-up, relative to 96.2% 30-day survival and 15 deaths over a median of 30 months follow-up in SOC heart recipients. Despite higher rates of transient right heart dysfunction and severe primary graft dysfunction, the use of DCD hearts appears to be feasible, safe, and effective in this initial United States single institution series.