68. 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: Plenary Session
Vanderbilt University
Nashville, TN
United States - Contact Me
Dr. Ashish S. Shah is the Alfred Blalock Director and Chair of Cardiac Surgery at Vanderbilt University Medical Center. He trained at Duke University Medical Center and served on the faculty of The Johns Hopkins Hospital for 10years before joining the faculty at Vanderbilt.
University of Pittsburgh
Pittsburgh, PA
United States - Contact Me
Dr. Nicholas Hess is an integrated cardiothoracic surgery resident at the University of Pittsburgh Medical Center. Prior to residency, he completed his medical degree at the University of Pittsburgh School of Medicine. His clinical and research interests incluce heart failure, heart transplantation, and mechanical circulatory support.
Saturday, May 6, 2023: 2:40 PM - 3:00 PM
20 Minutes
Los Angeles Convention Center
Room: West Hall B
Description
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.
Presentation Duration
8 minute presentation; 12 minute discussion