Heart transplantation continues to experience a shortage of donor organs. Heart donors may be more readily available for individuals with advanced heart failure if donation after circulatory death (DCD) hearts are used.
For a study, researchers sought to compare the hemodynamic and clinical characteristics of hearts donated after brain death (DBD) to those of standard-of-care (SOC) hearts.
The single-center retrospective cohort research compared the clinical results of DCD and DBD heart recipients regarding right heart catheterization measures, inotrope scores, echocardiograms, and clinical outcomes.
There were 166 SOC hearts and 47 DCD hearts implanted between February 2022 and April 2016. The median amount of time from DCD consent to transplant was less (17 days [6-28 days] vs. 70 days [23-240 days]; P<0.001) than the amount of time spent on the SOC waiting list. Right heart function was impaired in DCD recipients compared to SOC recipients at 1-week post-transplant (higher median right atrial pressure (10 mm Hg [8-13 mm Hg] vs. 7 mm Hg [5-11 mm Hg]; P<0.001), higher right atrial pressure to a pulmonary capillary wedge pressure ratio (0.64 [0.54-0.82] vs. 0.57 [0.43-0.73]; P=0.016), and lower pulmonary arterial pulsatility index (1.66 [1.27-2.50] vs. 2.52 [1.63-3.82]; P<0.001), but was similar between groups by 3 weeks post-transplant. At 30 days (DCD 0 vs SOC 2%; P=0.29) & 1 year (DCD 3% vs SOC 8%; P=0.16) post-transplant, recipient mortality for DCD & SOC was comparable.
Using DCD hearts results in short-term clinical outcomes that are comparable to those of DBD heart transplantation and a temporary post-transplant right ventricular malfunction.
Reference: jacc.org/doi/10.1016/j.jacc.2022.07.024
