Special FeatureOutcome after heart transplantation from donation after circulatory-determined death donors
Section snippets
Study description
This was a single-center observational matched cohort study comparing consecutive patients who received transplants of DCD donor heart between February 1, 2015, and March 31, 2017, vs matched recipients who received transplants of DBD donor hearts between February 1, 2013, and March 31, 2017. The DBD cohort period was extended to allow accurate matching given the heterogeneity of donors and recipients. There was no difference in implant technique or immunosuppressive regimens during this
Results
There were 40 potential DCD donors attended during the study (Figure 1). Thirty-five donors arrested within 4 hours after WLST, with 17 donor hearts undergoing NRP and 18 undergoing DPP. Three DCD hearts were declined in the DPP group after being instrumented on the OCS: 1 due to severe left ventricular hypertrophy, 1 due to a rapidly rising lactate, and 1 due to a subsequently detected abdominal malignancy. Four DCD hearts in the NRP group were declined during in situ NRP: 1 due to poor
Discussion
This study found the use of DCD donors resulted in an equivalent 90-day survival to that seen in contemporary DBD practice. In addition, early cardiac output was better in the DCD group. This may be explained by the elimination of cold ischemia during transportation; however, when cold storage and machine perfusion of DBD hearts were compared in the Randomized Study of Organ Care System Cardiac for Preservation of Donated Hearts for Eventual Transplantation (PROCEED II) trial, no difference in
Disclosure statement
S.M., S.L., and A.P. have received educational grants from TransMedics. S.M. and A.P. have received proctoring fees from TransMedics for DCD heart transplantation. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
The authors would like to thank the NHSBT specialist nurses and clinical leads in organ donation for their continued support. The authors also thank
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