A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors

TLDR

The study established a UK clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015 to meet rising transplant demand. The authors conducted a single-center, retrospective matched cohort study comparing 79 DCD heart transplants to 164 DBD transplants, retrieving DCD hearts via thoracoabdominal normothermic regional perfusion or direct procurement and perfusion, and measuring 30‑day and 1‑year survival. Over five years, DCD donation increased transplant activity by 48% and produced 30‑day and 1‑year survival rates (97% vs 99% and 91% vs 89%) comparable to DBD, with no differences in ICU or hospital stay, indicating DCD can expand patient access without compromising outcomes.

Abstract

In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program.This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK). DCD hearts were either retrieved using thoracoabdominal normothermic regional perfusion or the direct procurement and perfusion technique. All DBD hearts were procured using standard cold static storage. The primary outcomes were recipient 30-day and 1-year survival.During the 5-year study, DCD heart donation increased overall heart transplant activity by 48% (79 for DCD and 164 for DBD). There was no difference in survival at 30 days (97% for DCD vs 99% for DBD, p = 1.00) or 1 year (91% for DCD vs 89% for DBD, p = 0.72). There was no difference in the length of stay in the intensive care unit (7 for DCD vs 6 for DBD days, p = 0.24) or in the hospital (24 for DCD vs 25 for DBD days, p = 0.84).DCD heart donation increased overall heart transplant activity at RPH by 48%, with no difference in 30-day or 1-year survival in comparison with conventional DBD heart transplantations. DCD heart donation is set to make a dramatic difference in the number of patients who can benefit from heart transplantation.