Controlled DCD heart re-transplantation enabled by ex-situ normothermic perfusion: First UK case and implications for high-risk recipient selection

Cardiac re-transplantation is very rare and carries considerably increased peri-operative risk. Donation after circulatory death (DCD), combined with ex-situ normothermic perfusion, has expanded the donor pool with favourable early outcomes, but there is a paucity of experience of its use in cardiac re-transplantation. We report the first UK case of orthotopic heart re-transplantation using a controlled DCD donor preserved on ex-situ normothermic perfusion 140 days after index transplantation complicated by severe irrecoverable primary graft failure – defined as immediate presentation early graft dysfunction involving both ventricles as per recent International Society for Heart and Lung Transplantation guidelines.