1. Outcomes of Donation After Circulatory Death Heart Transplantation in Australia
- Author
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Michelle Harkness, Robert M. Graham, Mark Connellan, Sarah E. Scheuer, Peter S. Macdonald, Mark Hicks, Andrew Dinale, Ling Gao, Anne Keogh, Jeanette E. Villanueva, A. Watson, Hong Chee Chew, Claudio Soto, Christopher S. Hayward, Paul Jansz, Kavitha Muthiah, Phillip Spratt, Priya Nair, Arjun Iyer, Eugene Kotlyar, Kumud Dhital, Emily Granger, and Andrew Jabbour
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Donor Selection ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,medicine ,Extracorporeal membrane oxygenation ,Humans ,030212 general & internal medicine ,Heart transplantation ,Machine perfusion ,business.industry ,Graft Survival ,Australia ,Shock ,medicine.disease ,Transplantation ,Outcome and Process Assessment, Health Care ,Cardiovascular System & Hematology ,Ventricular assist device ,Donation ,Heart failure ,Cohort ,Emergency medicine ,Tissue and Organ Harvesting ,Heart Transplantation ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice. Objectives The purpose of this study is to provide an update on the authors’ Australian clinical program and discuss lessons learned since performing the world’s first series of distantly procured DCD heart transplants. Methods The authors report their experience of 23 DCD heart transplants from 45 DCD donor referrals since 2014. Donor details were collected using electronic donor records (Donate Life, Australia) and all recipient details were collected from clinical notes and electronic databases at St. Vincent’s Hospital. Results Hearts were retrieved from 33 of 45 DCD donors. A total of 12 donors did not progress to circulatory arrest within the pre-specified timeframe. Eight hearts failed to meet viability criteria during normothermic machine perfusion, and 2 hearts were declined due to machine malfunction. A total of 23 hearts were transplanted between July 2014 and April 2018. All recipients had successful implantation, with mechanical circulatory support utilized in 9 cases. One case requiring extracorporeal membrane oxygenation subsequently died on the sixth post-operative day, representing a mortality of 4.4% over 4 years with a total follow-up period of 15,500 days for the entire cohort. All surviving recipients had normal cardiac function on echocardiogram and no evidence of acute rejection on discharge. All surviving patients remain in New York Heart Association functional class I with normal biventricular function. Conclusions DCD heart transplant outcomes are excellent. Despite a higher requirement for mechanical circulatory support for delayed graft function, primarily in recipients with ventricular assist device support, overall survival and rejection episodes are comparable to outcomes from contemporary brain-dead donors.
- Published
- 2019
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