First to 50: Early Outcomes Following Heart Transplantation at Royal Papworth Hospital from Donation after Circulatory Determined Death (DCD) Donors

Abstract

Purpose The demand for heart transplantation has increased by 162% in the United Kingdom over the last decade. In an attempt to address both wait list mortality and prolonged waiting times, a programme of DCD heart transplantation was implemented at Royal Papworth Hospital in March 2015. We report the early outcomes of the first 50 DCD heart transplants and compare them to a matched cohort of donation after brain death (DBD) heart transplants. Methods DCD hearts were retrieved either by; Normothermic Regional Perfusion followed by ex-situ heart perfusion (NRP-ESHP), NRP followed by cold storage (NRP-CS) or Direct Procurement and Perfusion using ESHP alone (DPP-ESHP). During NRP, perfusion was restored to the arrested heart within the donor with the exclusion of the cerebral circulation whilst DPP hearts were removed directly. A retrospective cohort of DBD heart transplants, matched for donor and recipient characteristics was used as a comparison group. All DBD hearts were transported using static cold storage. Outcome measures for this study included 30 day survival as well post transplant inotrope dependence, mechanical support, initial cardiac performance, ventilator duration, intensive care duration and length of hospital stay. Results From 1st March 1 2015 to 10th October 50 DCD heart transplants were performed at our institute. Sixteen DCD hearts were transplanted following (NRP-ESHP), 32 hearts following (DPP-ESHP) and 2 hearts following (NRP-CS). The 30-day survival post transplant was 100% in both DCD and DBD groups. All other outcome variables were comparable between groups with the exception of Dopamine reliance post transplant, table 1. Values are median (IQR) or n (%) Conclusion After 50 DCD heart transplants, the results continue to show that DCD heart transplantation can be performed safely with comparable early outcomes to those achieved with DBD heart transplantation.