Outcomes after DCD Cardiac Transplantation: An international, multicenter retrospective study

Abstract

Background: As donation after circulatory determination of death (DCD) heart transplantation (HT) becomes more widely adopted, there is a need to establish the most clinically effective method of organ procurement. Objective: This international, multicenter study compares outcomes of DCD-HT across Europe and the United States (US) between recipients whose donor hearts were retrieved using thoraco-abdominal normothermic regional perfusion (taNRP) to those whose hearts were recovered using direct procurement and perfusion (DPP). Methods: This was a retrospective observational study across 20 heart transplant centers in Belgium, Spain, the United Kingdom (UK) and the US. This study included all patients undergoing DCD-HT at participating centers, from the start of each center’s DCD program through 01/01/2023. DCD-HT with recovery using either taNRP or DPP were compared to one-another. Post-transplant outcomes included (i)survival at 1-year, (ii)incidence of severe primary graft dysfunction (PGD), (iii)episodes of treated, biopsy-proven acute-cellular rejection (ACR) in the first year following transplantation. Results: 504 DCD-HT took place in the study period. Survival at one year was similar for taNRP and DPP recipients (91% vs 88%, p=0.1). taNRP recipients had a lower rate of severe PGD (7.6% vs 19.2%, p<0.001) and fewer episodes of biopsy-proven, ACR requiring treatment in the first-year post-transplantation (13% vs 25%,p<0.001). Conclusion: In an international study of DCD-HT, recipients of hearts retrieved by taNRP technique had lower rates of severe PGD and fewer episodes of biopsy-proven ACR in the first year when compared with those retrieved utilizing DPP. These results should be further investigated with randomized control trials.