Outcomes of Heart Transplantation Using Donation after Circulatory Death: Up-To-Date US Experience

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Abstract Submission 

Hosam Ahmed (1), Amalia Guzman-Gomez (2), Jason Greenberg (3), Kevin Kulshrestha (3), Eashwar Kantemneni (4), Farhan Zafar (5), David Morales (5)

(1) Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2) Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,, Cincinnati, OH, (3) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, (4) Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, University o, Cincinnati, OH, (5) Cincinnati Children's Hospital, Cincinnati, OH

Hosam Ahmed    -  Contact Me
Cincinnati Children's Hospital Medical Center

Amalia Guzman-Gomez    -  Contact Me
Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,

Jason Greenberg    -  Contact Me
Cincinnati Children’s Hospital Medical Center

Kevin Kulshrestha    -  Contact Me
Cincinnati Children’s Hospital Medical Center

Eashwar Kantemneni    -  Contact Me
Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, University o

Farhan Zafar    -  Contact Me
Cincinnati Children's Hospital

David Morales    -  Contact Me
Cincinnati Children's Hospital

Hosam Ahmed    -  Contact Me
Cincinnati Children's Hospital Medical Center

Objective: Recently, a number of centers in the US have begun performing donation after circulatory death (DCD) heart transplants (HTx) in adults with heart failure. We sought to characterize the recent national trends in HTx DCD donor utilization and outcomes in comparison with donation after brain death (DBD).

Methods: Using the United Network for Organ Sharing (UNOS) database, 11,206 adult (>18yo) HTx recipients from January 2019 to June 2022 were identified, of which 454 (4%) were DCD recipients and 10,752 (96%) were DBD recipients. Comparisons between groups were done using Student's t-test & Pearson's chi-squared test, & logistic regression. Univariable (Kaplan Meier) and multivariable (Cox hazards) regression was used to analyze post-transplant survival in DCD group.

Results: DCD recipients were older (57 vs 56y, P<0.001), more likely to be listed as status 2 (p<0.001), had longer wait times (44.0 vs 32.0 d, p=0.002), and more VAD use (p=0.002). DCD donors were younger (29 vs 32y, p<0.001), had longer ischemic time (4.9 vs 3.4 hrs, p<0.001), less renal dysfunction (p<0.001) in comparison with DBD group. Logistic regression analysis showed DCD recipients are more likely to be male (p=0.010) and heavier (p<0.001) and less likely to require ECMO or inotropes (p=0.034 & p<0.001, respectively). On multivariable regression, only longer waitlist time (30-150) was associated with post-transplant survival in DCD group (HR=2.071 [1.095–6.660]). Post-transplant length of stay was shorter in DCD cohort (16 vs 17, p=0.023). One and two-year survival were similar in both groups (P=0.700).

Conclusions: In this UNOS registry, DCD recipients had shorter length of hospital stay and similar post-transplant survival compared to DBD group. DCD recipients were less ill at transplant with greater VAD use. Long waitlist time is a risk factor for poor outcomes post DCD heart transplantation. Given early success with post-transplant survival, effort should be made to expand the pool of eligible recipients.

Cardiac Transplant and Mechanical Circulatory Support