Association of Post-Transplant Dialysis and Survival Following Donation after Circulatory Death Heart Transplantation

Abstract Background Renal failure is an important predictor of survival following heart transplantation. There is a paucity of literature exploring the association of renal impairment and donation after circulatory death (DCD) transplant outcomes. This study evaluated the effect of post-transplant renal failure requiring de novo dialysis on outcomes after DCD heart transplantation. Methods The UNOS registry was queried to analyze adult DCD heart transplant recipients between 01/01/2019 and 12/31/2023. The cohort was stratified according to de novo post-transplant dialysis requirement. The primary outcome was 1-year survival. Propensity score-matching was performed. Sub-analyses explored the association with donor classification of death and procurement strategy. Results A total of 1,122 patients who underwent DCD heart transplant were analyzed. Of these, 201 patients (17.9%) developed post-transplant renal failure requiring de novo dialysis. Post-transplant dialysis recipients experienced significantly lower 1-year survival compared to those without post-transplant dialysis in both the unmatched (74.2% vs 96.3%, p < 0.001) and matched comparisons (73.4% vs 95.0%, p < 0.001). DCD recipients had increased odds of post-transplant dialysis requirement compared to DBD recipients; however, 1-year survival rates between DCD and DBD recipients requiring post-transplant dialysis were comparable. Conclusion Renal failure requiring post-transplant de novo dialysis is a detrimental complication associated with reduced survival following DCD heart transplantation. While the incidence of this complication is increased among DCD recipients, the survival is comparable to DBD recipients. DCD allografts can safely expand the donor pool but warrants careful evaluation of factors that increase the likelihood of post-transplant dialysis to optimize survival outcomes.