No elevated mortality risk with heart transplants donated after circulatory death
Patients with heart transplants involving donation after circulatory death have no detectable difference in survival compared with those with hearts donated after brain death, according to a study published in Circulation: Heart Failure.
Using data from the United Network for Organ Sharing (UNOS) registry, the researchers identified adult heart transplant recipients from January 2019 to September 2021 and used propensity-score matching to compare 1-year mortality between patients with hearts donated after circulatory death and those with hearts donated after brain death.
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“Heart transplantation with donation after circulatory death presents a new strategy to further increase donor availability, and surveillance of outcomes is imperative as adoption of donation after circulatory death heart transplantation expands,” Jennie H. Kwon, DO, a resident at Medical University of South Carolina, and colleagues wrote.
A total of 7,496 heart transplant recipients were analyzed; 229 with donation after circulatory death (DCD) and 7,267 with donation after brain death (DBD).
The researchers found that the 1-year survival was 92.5% for DCD transplants vs. 90.3% for DBD transplants (HR = 0.8; 95% CI, 0.44-1.43; P = .44).
Kwon and colleagues also found that the proportion of centers performing DCD transplants rose from 2.5% in 2019 to 16.5% in 2021 (Pearson R = 0.978; P < .001), and that the frequency of DCD heart transplantation rose from 0.2% in 2019 to 6.4% in 2021 (P < .001).
Furthermore, recipients for DCD transplants were more likely to receive the transplant while at UNOS statuses 3 to 6, whereas DBD recipients were more likely to be transplanted at status 1 or 2.
When analyzing secondary outcomes, the researchers found that after propensity matching, acute rejection requiring treatment before discharge was more common in DCD recipients than DBD recipients (14.7% vs. 10.1%; P = .03), but there was no difference in length of hospital stay, rates of dialysis, rates of stroke or pacemaker implantation.
“With 229 patients, this report represents the largest registry analysis of DCD heart transplantation in the U.S. published to date,” Kwon and colleagues wrote. “We demonstrate that although DCD heart transplantation occurred in a highly selected group of donors and recipients, DCD was not associated with an elevated hazard for 1-year posttransplant mortality in a propensity-matched cohort.”
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Kwon JH, et al. Circ Heart Fail. 2022;doi:10.1161/CIRCHEARTFAILURE.122.009844.