Severe Primary Graft Dysfunction in Heart Transplant Recipients Using Donor Hearts After Circulatory Death: United States Experience

Peter D Cho; Samuel T Kim; Hedwig Zappacosta; John P White; Stephanie McKay; Reshma Biniwale; Abbas Ardehali

doi:10.1016/j.healun.2024.11.027

Severe Primary Graft Dysfunction in Heart Transplant Recipients Using Donor Hearts After Circulatory Death: United States Experience

J Heart Lung Transplant. 2024 Nov 27:S1053-2498(24)01972-7. doi: 10.1016/j.healun.2024.11.027. Online ahead of print.

Authors

Peter D Cho¹, Samuel T Kim², Hedwig Zappacosta³, John P White³, Stephanie McKay³, Reshma Biniwale⁴, Abbas Ardehali⁵

Affiliations

¹ Drexel University College of Medicine, Philadelphia, PA, USA.
² David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, CA, USA.
³ David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁴ Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, CA, USA.
⁵ Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, CA, USA. Electronic address: aardehali@mednet.ucla.edu.

PMID: 39613119
DOI: 10.1016/j.healun.2024.11.027

Abstract

Objective: This study compares the incidence of severe Primary Graft Dysfunction (PGD) in a contemporaneous cohort of donors after circulatory death (DCD) and brain death (DBD) heart transplant recipients.

Method: The United Network for Organ Sharing database was queried for isolated adult heart transplant recipients from 9/2023 to 6/2024. Heart recipients were stratified based on the organ donation type (DCD vs DBD). DCD heart recipients were further categorized based on the procurement method: time between circulatory death to cross-clamp: ≤ 30 minutes (Direct Procurement and Preservation, DPP), >30 minutes (Normothermic Regional Perfusion, NRP). Outcomes of interest included: severe PGD (Left/Bi-Ventricular; LV/BiV) at 24 hours and Severe Graft Dysfunction at 72 hours (patients with severe PGD at 24 hours that remain on mechanical support at 72 hours).

Results: A total of 2,590 adult heart transplant recipients were identified, of which 17.1% underwent DCD heart transplantation. DCD heart recipients were less likely to be on inotrope (36.7% vs 41.6%, p=0.046) and ECMO (4.1% vs 9.9%, p<0.001) prior to transplant than DBD heart recipients. DCD heart recipients were more likely than DBD heart recipients to develop severe PGD (LV/BiV) at 24 hours (9.5% vs 5.1%, p<0.001). The Severe Graft Dysfunction at 72 hours (2.3% vs 2.9%, p=0.67) and 30-day mortality were similar between the 2 groups. Recipients of DCD heart procured with DPP or NRP had similar severe PGD (LV/BiV) at 24 hours (9.4% vs 9.7%, p=0.93).

Conclusion: Severe PGD at 24 hours is higher among the DCD than DBD heart recipients, but Graft Dysfunction improves by 72 hours.

Keywords: Heart transplantation; donation after brain death; donation after determination of circulatory death; normothermic regional perfusion; primary graft dysfunction.