One Year Cardiac Allograft Vasculopathy (cav) Outcomes in Donor after Circulatory Death (dcd) Heart Transplant Recipients

PurposeCardiac allograft vasculopathy (CAV) is a leading cause of mid- and long-term morbidity and mortality in heart transplant (HTx) recipients. However, there is limited data in donor after circulatory death (DCD) HTx recipients where ischemia reperfusion injury may contribute to development of CAV. The goal of this study is to compare CAV outcomes in DCD and donor after brain death (DBD) HTx recipients.MethodsThis single-center, retrospective study included DCD and DBD HTx recipients from September 2019 to September 2021. Patients were followed for clinical outcomes through October 2022. CAV was defined using established angiographic and intravascular ultrasound (IVUS) criteria according to International Society of Heart and Lung Transplant (ISHLT) and Stanford classification guidelines.ResultsA total of 165 HTx patients were included with 36 DCD and 129 DBD recipients. Baseline characteristics were similar between DCD and DBD recipients including median age (60.9 years vs 55.9 years, p = 0.116), male sex (88.9% vs 76.7%, p = 0.111) and Caucasian race (44.4% vs 35.7%, p = 0.526). Notable differences included lower UNOS status and decreased requirement of pre HTx mechanical circulatory support in DCD compared to DBD recipients. In addition, DCD donors were younger (30.5 years vs 33.6 years, p = 0.006) and more obese [BMI ≥ 30] (38.8% vs 30.2%, p = 0.037) compared to DBD donors. With respect to clinical outcomes at 1 year, there were no significant differences in mortality and CAV (Table 1). However, there was a trend toward significance with greater CAV, when defined using Stanford class 4, in DBD compared to DCD recipients (Table 1).ConclusionIn one of the largest cohorts of DCD HTx recipients, there was no significant difference in CAV at 1 year between DCD and DBD HTx recipients. However, there was a trend towards increased CAV, defined as Stanford Class 4, in DBD patients. Further work is needed to confirm these findings and investigate differences in donor characteristics. Cardiac allograft vasculopathy (CAV) is a leading cause of mid- and long-term morbidity and mortality in heart transplant (HTx) recipients. However, there is limited data in donor after circulatory death (DCD) HTx recipients where ischemia reperfusion injury may contribute to development of CAV. The goal of this study is to compare CAV outcomes in DCD and donor after brain death (DBD) HTx recipients. This single-center, retrospective study included DCD and DBD HTx recipients from September 2019 to September 2021. Patients were followed for clinical outcomes through October 2022. CAV was defined using established angiographic and intravascular ultrasound (IVUS) criteria according to International Society of Heart and Lung Transplant (ISHLT) and Stanford classification guidelines. A total of 165 HTx patients were included with 36 DCD and 129 DBD recipients. Baseline characteristics were similar between DCD and DBD recipients including median age (60.9 years vs 55.9 years, p = 0.116), male sex (88.9% vs 76.7%, p = 0.111) and Caucasian race (44.4% vs 35.7%, p = 0.526). Notable differences included lower UNOS status and decreased requirement of pre HTx mechanical circulatory support in DCD compared to DBD recipients. In addition, DCD donors were younger (30.5 years vs 33.6 years, p = 0.006) and more obese [BMI ≥ 30] (38.8% vs 30.2%, p = 0.037) compared to DBD donors. With respect to clinical outcomes at 1 year, there were no significant differences in mortality and CAV (Table 1). However, there was a trend toward significance with greater CAV, when defined using Stanford class 4, in DBD compared to DCD recipients (Table 1). In one of the largest cohorts of DCD HTx recipients, there was no significant difference in CAV at 1 year between DCD and DBD HTx recipients. However, there was a trend towards increased CAV, defined as Stanford Class 4, in DBD patients. Further work is needed to confirm these findings and investigate differences in donor characteristics.