TOPLINE

Recipients of hearts from donors after circulatory death had 10-year survival, rates of severe primary graft dysfunction, and an incidence of cardiac allograft vasculopathy similar to those observed in recipients of hearts from donors after brain death.

METHODOLOGY

• Researchers conducted an observational study to compare 10-year survival and graft health among recipients of heart transplants based on the mode of death of the donor.
• They reviewed records of 503 recipients of heart transplants at a Sydney hospital between 2014 and 2024. Recipients had a mean age of 52-53 years and were predominantly male.
• Among the recipients, 118 received hearts from donors after circulatory death, with the hearts maintained via a warm perfusion system. The other 385 received hearts from donors after brain death, with the hearts preserved in a cold solution (occasionally with cold perfusion).
• Primary outcomes included overall survival at 30 days, 1 year, and 10 years post-transplant and the incidence of severe primary graft dysfunction. Secondary outcomes included freedom from cardiac allograft vasculopathy, the new requirement for permanent dialysis, and the incidence of disabling stroke.

TAKEAWAY

• Recipients of hearts donated after circulatory death had survival rates of 98% at 30 days, 94% at 1 year, and 67% at 10 years, whereas recipients of hearts donated after brain death had corresponding rates of 95%, 88%, and 64%; the differences were not statistically significant.
• The rates of freedom from cardiac allograft vasculopathy at 10 years were 61% vs 41% among recipients of hearts donated after circulatory death vs brain death, with no significant difference between the groups.
• Severe primary graft dysfunction affected 14% of the recipients in both groups. Among the recipients of hearts donated after circulatory death, each additional minute of asystolic warm ischemic time was an independent risk factor (P = .03).
• Recipients in both groups had similar rates of disabling stroke and a new permanent need for dialysis post-transplant.

IN PRACTICE

“[The] findings confirm that DCD heart transplantation provides long-term outcomes similar to those of DBD heart transplantation and indicate that the potential pool of DCD donors can be safely expanded by increasing the upper limit of donor age to 55 years,” the researchers of the study wrote.

SOURCE

The study was led by Yashutosh Joshi, MBBS, St Vincent’s Hospital Sydney, Darlinghurst, Australia. It was published online on June 10 in JACC: Heart Failure.

LIMITATIONS

The study was a retrospective observational analysis from a single center. Longer donor preservation times and more long‑distance retrievals in certain groups may have introduced confounding. Death was a competing risk for cardiac allograft vasculopathy, which may have led to overestimation or underestimation of its true rate.

DISCLOSURES

The study received philanthropic support from the Curran Foundation. One author reported receiving grants, personal fees, and research module support from multiple commercial and noncommercial sources, nonfinancial support from professional societies, and holding stock options in a private company.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.