5. Outcomes of Heart Transplantation Using Donation after Circulatory Death: Up-To-Date US Experience
Cleveland Clinic
Cleveland, OH
United States - Contact Me
Edward Soltesz, MD, MPH, is the Donna and Ken Lewis Endowed Chair in Cardiothoracic Surgery and the Surgical Director of the Kaufman Center for Heart Failure and Recovery at the Cleveland Clinic in Cleveland, OH. He also is the Course Director for the American Austrian Foundation/Open Medical Institute Cardiac Surgery Medical Seminar held annually in Salzburg, Austria, and the Director of Cardiac Surgery Affiliate Programs at Cleveland Clinic where he oversees quality and outcomes of more than 15 affiliated programs and 45 surgeons.
A native of Cleveland, Dr. Soltesz graduated as valedictorian of St. Ignatius High School in Cleveland and received a full academic scholarship to the College of the Holy Cross. There, he obtained degrees in both Classics and Chemistry, was awarded the British Marshall Scholarship, and graduated summa cum laude as the class valedictorian. Dr. Soltesz then went on to receive his medical degree from Harvard Medical School where he was awarded the Harvard National Scholarship. Dr. Soltesz stayed at Harvard to complete his residences in general surgery and cardiothoracic surgery at the Brigham and Women's Hospital in Boston. Dr. Soltesz also earned a Master of Public Health from Harvard University School of Public Health with a focus on clinical effectiveness. Dr. Soltesz then returned to Cleveland to complete an additional fellowship in complex aortic and endovascular surgery at Cleveland Clinic, where he was subsequently appointed to the Department of Thoracic and Cardiovascular Surgery in 2008.
Dr. Soltesz’s research program focuses on large-scale assessment of cardiac surgical outcomes from a public health perspective, quality improvement and safety, clinical outcomes of valve surgery, and heart failure. He has lectured and served as a visiting professor both nationally and internationally.
Cincinnati Children's Hospital Medical Center
Cincinnati, OH
United States - Contact Me
Hosam Ahmed is a Research Fellow in Cardiothoracic surgery at Cincinnati Children’s Hospital Medical Center (Cincinnati, Ohio, US). He served as a Registrar & Lecturer in Cardiothoracic Surgery at Assiut University Hospitals and School of Medicine (Assiut, Egypt) and a research fellow at the University of Florida Heart Center (Gainesville, Florida, US). Hosam is fully registered with a license to practice as a Cardiothoracic registrar (SpR) in the UK. His research interests include clinical and translational research related to outcomes following Cardiothoracic Surgeries including Heart and Lung Transplantation. Hosam is the recipient of Every Heartbeat Matters Valve Fellowship in 2019 by the American Association for Thoracic Surgery (AATS) to enhance heart valve disease treatment, knowledge and skill training for surgeons around the world who treat individuals with limited access to healthcare.
Abstract
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.