Donation After Circulatory Death Reduces Waitlist Times for Select Heart Transplant Recipients with Post-Transplant Outcomes Similar to Those Achieved with Standard Brain Dead Donors
Presented During:
Saturday, May 6, 2023: 2:40PM - 3:00PM
Los Angeles Convention Center
Posted Room Name:
West Hall B
Abstract No:
68
Submission Type:
Abstract Submission
Authors:
Nicholas Hess (1), Pyongsoo Yoon (2), Johannes Bonatti (3), Ibrahim Sultan (4), Derek Serna-Gallegos (4), Danny Chu (5), David Kaczorowski (6)
Institutions:
(1) University of Pittsburgh, Pittsburgh, PA, (2) UPMC PASSAVANT, Pittsburgh, PA, (3) UPMC Heart and Vascular Institute, Pittsburgh, PA, (4) University of Pittsburgh Medical Center, Pittsburgh, PA, (5) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, (6) University of Pittsburgh Medical Center, Venetia, PA
Submitting Author:
Nicholas Hess
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University of Pittsburgh
University of Pittsburgh
Co-Author(s):
Pyongsoo Yoon
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UPMC PASSAVANT
UPMC PASSAVANT
♦Johannes Bonatti
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UPMC Heart and Vascular Institute
UPMC Heart and Vascular Institute
*Ibrahim Sultan
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Derek Serna-Gallegos
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
*Danny Chu
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Veterans Affairs Pittsburgh Healthcare System
Veterans Affairs Pittsburgh Healthcare System
*David Kaczorowski
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Presenting Author:
Nicholas Hess
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University of Pittsburgh
University of Pittsburgh
Abstract:
Objective: The purpose of this study was to quantitate the impact of heart donation after circulatory death on waitlist times and post-transplant outcomes, including post-transplant peri-operative survival, in the United States.
Methods: A retrospective review utilizing the United Network for Organ Sharing database from October 18, 2018 to June 30, 2022 was performed. Adult recipients that underwent isolated heart transplantation within the United States utilizing either donation after brain death (DBD) or donation after circulatory death (DCD) were analyzed. The primary outcome was median waitlist time. Other outcomes included 90-day post-transplant survival, and post-transplant complications.
Results: Since 10/18/2018, a total of 10,368 isolated adult heart transplants were performed, including 9,954 (96.0%) utilizing DBD donors and 414 (4.0%) utilizing DCD. On average, DCD donors were younger (28 vs 32 years; P<0.001) and had a higher left ventricular ejection fraction (62% [IQR 60-66%] vs 60% [IQR 56-65]; P=0.002). Median donor-recipient hospital distances were farther with DCD donation [351 miles vs 224 miles; P<0.001) with a longer median total graft ischemic time (4.8 hours vs 3.4 hours; P<0.001). Overall, median waitlist time was shorter in recipients from DBD donors (47 days vs 33 days; P=0.001). However, the greatest proportion of DBD donors were allocated to Status 2 recipients across all blood types (Figure A) whereas the greatest proportion of DCD donors were allocated to Status 4 recipients across all blood types (Figure B). Of all recipients transplanted as a Status 1 or 2, there was a nonsignificant reduction in median waitlist times with DCD donation (15 days [IQR 5-48] vs 17 days [IQR 6-69]. Among Status 3 or 4 recipients, median waitlist time was significantly reduced with DCD donation (73 days [IQR 19-246] vs 91 days [IQR 24-314], P=0.040). 90-day survival was similar for recipients of DBD and DCD hearts (Figure C). Perioperative stroke was comparable between cohorts, as were rates of renal failure, and acute rejection within the first year.
Conclusions: DCD heart donation represents one means of alleviating the current shortage of donor hearts for transplantation. These data demonstrate that utilization of DCD hearts is particularly beneficial to select candidate populations, such as those with lower priority status. Further, use of DCD donors results in similar post-transplant outcomes compared to DBD donors.
Methods: A retrospective review utilizing the United Network for Organ Sharing database from October 18, 2018 to June 30, 2022 was performed. Adult recipients that underwent isolated heart transplantation within the United States utilizing either donation after brain death (DBD) or donation after circulatory death (DCD) were analyzed. The primary outcome was median waitlist time. Other outcomes included 90-day post-transplant survival, and post-transplant complications.
Results: Since 10/18/2018, a total of 10,368 isolated adult heart transplants were performed, including 9,954 (96.0%) utilizing DBD donors and 414 (4.0%) utilizing DCD. On average, DCD donors were younger (28 vs 32 years; P<0.001) and had a higher left ventricular ejection fraction (62% [IQR 60-66%] vs 60% [IQR 56-65]; P=0.002). Median donor-recipient hospital distances were farther with DCD donation [351 miles vs 224 miles; P<0.001) with a longer median total graft ischemic time (4.8 hours vs 3.4 hours; P<0.001). Overall, median waitlist time was shorter in recipients from DBD donors (47 days vs 33 days; P=0.001). However, the greatest proportion of DBD donors were allocated to Status 2 recipients across all blood types (Figure A) whereas the greatest proportion of DCD donors were allocated to Status 4 recipients across all blood types (Figure B). Of all recipients transplanted as a Status 1 or 2, there was a nonsignificant reduction in median waitlist times with DCD donation (15 days [IQR 5-48] vs 17 days [IQR 6-69]. Among Status 3 or 4 recipients, median waitlist time was significantly reduced with DCD donation (73 days [IQR 19-246] vs 91 days [IQR 24-314], P=0.040). 90-day survival was similar for recipients of DBD and DCD hearts (Figure C). Perioperative stroke was comparable between cohorts, as were rates of renal failure, and acute rejection within the first year.
Conclusions: DCD heart donation represents one means of alleviating the current shortage of donor hearts for transplantation. These data demonstrate that utilization of DCD hearts is particularly beneficial to select candidate populations, such as those with lower priority status. Further, use of DCD donors results in similar post-transplant outcomes compared to DBD donors.
ADULT CARDIAC:
Cardiac Transplant and Mechanical Circulatory Support
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