Hearts donated after circulatory vs brain death tied to post-transplant dysfunction

Utilization of hearts donated after circulatory death (DCD) appears to result in transient post-transplant right heart dysfunction and short-term clinical outcomes otherwise comparable to transplantation using hearts donated after brain death (DBD), reveals a recent study.

Consecutive heart transplant recipients were included in this single-centre retrospective cohort study. The authors analysed right heart catheterization measurements, inotrope scores, echocardiograms, and clinical outcomes between DCD and DBD heart recipients.

Overall, 47 DCD and 166 standard of care (SOC) hearts were transplanted between April 2016 and February 2022. Median time from consent to transplant was significantly shorter with DCD compared with SOC waiting list time (17 vs 70 days; p<0.001).

DCD recipients had significantly impaired right heart function compared with SOC recipients 1 week after transplantation (higher median right atrial pressure [10 vs 7 mm Hg; p<0.001], higher right atrial pressure to pulmonary capillary wedge pressure ratio [0.64 vs 0.57; p=0.016], and lower pulmonary arterial pulsatility index [1.66 vs 2.52; p<0.001]) but was similar between groups by 3 weeks post-transplant.

Mortality rates between DCD and SOC recipients were similar at 30 days (0 percent vs 2 percent; p=0.29) and 1 year after transplantation (3 percent vs 8 percent; p=0.16).

“Donor organ demand continues to outpace supply in heart transplantation,” the authors said. “Utilization of DCD hearts could significantly increase heart donor availability for patients with advanced heart failure.”