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The increased use of donors after circulatory death (DCD) has expanded the breath of organ donation across many heart transplant centers. However, there are concerns about the stability and quality of the donors compared to traditional donors after brain death (DBD) organs. The objective of our study is to analyze the differences between DCD compared to DBD. Single center, retrospective data from donors procured after the inception of the DCD program at our institution. We compared donor characteristics and graft function between DCD and DBD. From 2020 to 2022, 165 donors were procured by our transplant program. Donor procurement characteristics showed a significant difference between age of donor and total ischemic time. Graft function at 90 days post-heart transplant was well preserved and rates of primary graft dysfunction and need for short term MCS where similar among both donor organs. Organs from DCD donors are comparable in mode of death, ischemic time and graft function after transplant. The rates of PGD and need for MCS after transplantation did not differ among both cohorts. More studies are needed to determine the long-term outcomes of DCD organs compared to DBD. [ABSTRACT FROM AUTHOR]

Heart transplants (HT) from donors after circulatory death (DCD) have been slowly adopted in the United States. Differences in procurement of DCD organs could increase risk of graft dysfunction due to prolonged ischemia after withdrawal of life-support and agonal time. Two methods exist for DCD heart procurement: an ex vivo perfusion system (TransMedics Organ Care System [OCS]) and normothermic regional perfusion (NRP) with extracorporeal membrane oxygenation. The differences of each procurement method could be responsible for abnormal hemodynamic indices. We sought to compare hemodynamic parameters in HT from donor after brain death (DBD) vs DCS and OCS vs NRP donors. Single-center, retrospective study of all HT performed at our institution beginning the year of our first DCD HT. We divided our cohort by DBD and DCD transplants. In addition, we compared the two methods of DCD procurement, OCS and NRP. Measurements from protocolized, routine right heart catheterizations (RHC) at 10 to 14 days post-transplant were used for this analysis. A total of 226 HT from 01/2020 to 9/2022 were included, 154 (68.1%) DBD and 72 (31.9%) DCD HT. Within the DCD cohort, 16 (22%) were procured by OCS and 56 (78%) by NRP. The RHC was performed at a mean of 10.8 days (SD 2.3). When comparing DBD to DCD, the only significant difference was mean pulmonary artery pressure. (Table 1) No statistically significant differences in hemodynamics were observed between the two methods of DCD procurement (Table 2). Hemodynamic indices were similar between DCD and DBD HT recipients when measured around day 10 post-transplant. In particular, there were no differences in the parameters of RV dysfunction. Similarly, no differences were observed when comparing types of DCD procurement, OCS and NRP. These findings suggest that graft quality should be considered equal regardless of the type of donor or method of procurement. [ABSTRACT FROM AUTHOR]

Cardiac allograft vasculopathy (CAV) is a leading cause of mid- and long-term morbidity and mortality in heart transplant (HTx) recipients. However, there is limited data in donor after circulatory death (DCD) HTx recipients where ischemia reperfusion injury may contribute to development of CAV. The goal of this study is to compare CAV outcomes in DCD and donor after brain death (DBD) HTx recipients. This single-center, retrospective study included DCD and DBD HTx recipients from September 2019 to September 2021. Patients were followed for clinical outcomes through October 2022. CAV was defined using established angiographic and intravascular ultrasound (IVUS) criteria according to International Society of Heart and Lung Transplant (ISHLT) and Stanford classification guidelines. A total of 165 HTx patients were included with 36 DCD and 129 DBD recipients. Baseline characteristics were similar between DCD and DBD recipients including median age (60.9 years vs 55.9 years, p = 0.116), male sex (88.9% vs 76.7%, p = 0.111) and Caucasian race (44.4% vs 35.7%, p = 0.526). Notable differences included lower UNOS status and decreased requirement of pre HTx mechanical circulatory support in DCD compared to DBD recipients. In addition, DCD donors were younger (30.5 years vs 33.6 years, p = 0.006) and more obese [BMI ≥ 30] (38.8% vs 30.2%, p = 0.037) compared to DBD donors. With respect to clinical outcomes at 1 year, there were no significant differences in mortality and CAV (Table 1). However, there was a trend toward significance with greater CAV, when defined using Stanford class 4, in DBD compared to DCD recipients (Table 1). In one of the largest cohorts of DCD HTx recipients, there was no significant difference in CAV at 1 year between DCD and DBD HTx recipients. However, there was a trend towards increased CAV, defined as Stanford Class 4, in DBD patients. Further work is needed to confirm these findings and investigate differences in donor characteristics. [ABSTRACT FROM AUTHOR]

Orthotopic heart transplantation (OHT) remains the gold standard for advanced heart failure. Two pathways exist to deceased donor heart graft donation: Traditional brain-dead donor (DBD) and recently donation after circulatory death (DCD). However, the impact of DCD donor hearts on the outcome of adult OHT recipients remains unclear. The aim of this study was to compare the outcome of adult OHT recipients between DCD and DBD donor grafts. Data were obtained from single center institutional database. All adult patients undergoing OHT from September 2019 through September 2021 were included (n = 165). Propensity scores for DCD donors were calculated. Patients were matched 1:1 based on the propensity score of each patient. The impact of DCD donors on post-transplant outcomes was investigated. Overall survival probability analysis was performed. From September 2019 through September 2021, 165 OHTs were performed. DCD donors accounted for 36 (21.8%). Following matching, 72 patients were available for analysis. There were no significant differences in baseline characteristics between DCD and DBD recipients. ISHLT primary graft dysfunction (63.89% vs 75% p=0.31) and need for mechanical circulatory support (IABP and ECMO) (16.67% vs. 33.33% p = 0.10) occurred less commonly amongst DCD cases but was not statistically significant. There were no differences in hospital length of stay (15 vs 16 days p=0.44), median left ventricular ejection fraction at 90 days (61% vs 63.5% p=0.45), and 90-day survival (100% vs 91.67% p=0.07). One year survival (100% vs 89.66 p=0.08) and Kaplan Meier survival analysis were not statistically significant between groups (p = 0.303) (Figure). Cardiac allograft vasculopathy at 1 year was similar (61.5% vs. 67.86% p=0.63). DCD heart grafts yielded similar outcomes when compared to a matched DBD cohort. Increased use of DCD donor grafts can potentially alleviate the persistent shortage of available donor organs and shorten the waitlist time for heart transplantation. [ABSTRACT FROM AUTHOR]