Transplantation with hearts donated after circulatory death appears feasible
Recipients of hearts donated after circulatory death had similar outcomes to recipients of hearts donated after brain death, researchers reported.
“A shortage of donation after brain death (DBD) donors for heart transplantation (HT) persists. Recent improvements in organ procurement from donation after circulatory death (DCD) donors and promising early results of DCD-HTs from Europe and Australia have renewed interest in DCD-HT,” Shivank Madan, MD, MHA, medical director of clinical trials at Montefiore Medical Center and assistant professor of medicine at Albert Einstein Medical College, and colleagues wrote in the Journal of the American College of Cardiology.
Madan and colleagues analyzed 127 DCD-HT recipients (mean age, 54 years; 28% women) and 2,981 DBD-HT recipients (mean age, 57 years; 26% women) included in the United Network for Organ Sharing registry from January 2020 to February 2021 with available posttransplant follow-up.
Compared with DBD donors, DCD donors were younger (median age, 29 years vs. 32 years; P < .05), less likely to be female (11.02% vs. 28.67%; P < .05), had higher median left ventricular ejection fraction (62% vs. 60%; P < .05) and had longer median total ischemic time (5.9 hours vs. 3.4 hours; P < .05), according to the researchers.
No difference in survival
At a median follow-up of 6.1 months for recipients, there was no difference between the DCD and DBD groups in mortality (DCD, 5.4%; DBD, 7.6%; adjusted HR = 0.49; 95% CI, 0.18-1.32; P = .158), Madan and colleagues wrote.
There was also no difference between the groups in primary graft failure at 30 days, in-hospital stroke, pacemaker implantation, hemodialysis and length of hospital stay after transplantation.
A propensity-matched analysis did not change the results.
The number of DCD heart donors has risen from 871 in 2010 to 3,045 in 2020, and widespread adoption of DCD hearts for transplantation could lead to an additional 300 transplants being performed in the U.S. each year, Madan and colleagues wrote.
“It is also important to mention that the current study included a period when large parts of United States were affected by the COVID-19 pandemic; resulting in severe restrictions and challenges for organ procurement organizations and HT programs. Thus, one could expect the volume of adult DCD-HT to be substantially higher in the coming years, especially with the ongoing trajectory of increasing DCD donors,” Madan and colleagues wrote. “Although one could argue that approximately 300 additional adult DCD-HTs each year may be an underestimate or overestimate, any increase in HT from donors who are currently being discarded should be considered a step in the right direction, especially considering equivalent early outcomes. This projection also raises the stakes for the ongoing DCD-HT trial, which could lead to widespread increase in DCD-HT rates if the trial results are favorable.”
‘Crucial strategy’
In a related editorial, Francis D. Pagani, MD, PhD, Otto Gago MD Endowed Professor in Cardiac Surgery at University of Michigan Health, wrote that the study “is an important
summary of an early U.S. experience using DCD donors for heart transplantation and provides further data to support this approach as a crucial strategy to expand the donor heart pool.”
He noted, however, that “the use of DCD donors currently requires a significant increase in resources that will appreciably increase the cost and resource utilization associated with heart transplantation,” which means that “the obvious concern is that greater cost and resource utilization will limit DCD heart transplantation to large financially affluent transplant centers, increasing regional disparities in access to heart transplantation.”
Reference:
Collapse