Donation after Circulatory Death Heart Transplantation - The First 5 Years a Successful Leap in Activity

Abstract

Purpose Donation after circulatory death (DCD) heart transplantation was reinstated in response to the critical shortage of donor hearts from donation after brain death (DBD). Promising early results prompted centres in Europe, Australia and United States to adopt this practice. A clinical DCD heart transplant programme was initiated at our centre in March 2015. We aim to review our experience to date. Methods The study included recipients of DCD heart transplant from 1st of March 2015 to 31st October 2020. Comparison was made with the concurrent group of DBD heart recipients from our centre who were matched on donor and recipient characteristics. DCD hearts were retrieved by one of the three methods practised at our institution: 1. Thoraco-abdominal normothermic regional perfusion followed by ex-situ machine perfusion (TANRP-MP), 2. TANRP followed by cold storage (TANRP-CS) or 3. Direct procurement and perfusion (DPP) utilising ex-situ machine perfusion. All DBD hearts were preserved by cold storage. The 2 primary outcome measures were survival and primary graft dysfunction requiring temporary mechanical circulatory support (MCS). Results 85 DCD heart transplants were performed over the studied period. 62 hearts were retrieved by DPP, 20 by TANRP-MP and 3 by TANRP-CS. 30-day patient survival was comparable between groups (p=0.76), with 95% for DCD and 94% for DBD. 90% of DCD patients survived to 1 year vs 91% of their DBD matches. 5-year survival was 87% in the DCD and 83% in the DBDs. 33% of DCD patients required MCS post-transplant vs 24% of DBD patients (p=0.24). Support with V-A ECMO was necessary for 11 DCD and 5 DBD recipients (p=0.21). Early cardiac function appeared better in the DCD group (CI 2.3 vs 1.9, p=0.08). Secondary outcome measures were similar between the groups, table 1. Conclusion DCD heart transplantation appears to be equivalent to traditional DBD transplantation. 5-year outcomes of our 85-patient cohort including acute rejection rates support this conclusion.