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Outcome after heart transplantation from donation after circulatory-determined death donors

https://doi.org/10.1016/j.healun.2017.10.021Get rights and content

Background

The requirement for heart transplantation is increasing, vastly outgrowing the supply of hearts available from donation after brain death (DBD) donors. Transplanting hearts after donation after circulatory-determined death (DCD) may be a viable additive alternative to DBD donors. This study compared outcomes from the largest single-center experience of DCD heart transplantation against matched DBD heart transplants.

Methods

DCD hearts were retrieved using normothermic regional perfusion (NRP) or direct procurement and perfusion (DPP). During NRP, perfusion was restored to the arrested heart within the donor with the exclusion of the cerebral circulation, whereas DPP hearts were removed directly. All hearts were maintained on machine perfusion during transportation. A retrospective cohort of DBD heart transplants, matched for donor and recipient characteristics, was used as a comparison group. The primary outcome measure of this study (set by the United Kingdom regulatory body) was 90-day survival.

Results

There were 28 DCD heart transplants performed during the 25-month study period. Survival at 90 days was not significantly different between DCD and matched DBD transplant recipients (DCD, 92%; DBD, 96%; p = 1.0). Hospital length of stay, treated rejection episodes, allograft function, and 1-year survival (DCD, 86%; DBD, 88%; p = 0.98) were comparable between groups. The method of retrieval (NRP or DPP) was not associated with a difference in outcome.

Conclusions

These results suggest that heart transplantation from DCD heart donation provides comparable short-term outcomes to traditional DBD heart transplants and can serve to increase heart transplant activity in well-selected patients.

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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