What does this research mean for the field?

Heart transplantation using donation after circulatory death in patients with a left ventricular assist device results in similar one-year survival compared to donation after brain death. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare early post-transplant survival and clinical outcomes between donation after circulatory death (DCD) and donation after brain death (DBD) heart transplants among patients with left ventricular assist devices (LVADs).

June 26, 2025ESC Heart FailureOpen Access

Heart Transplantation Outcomes with Donation After Circulatory Death in Patients with Left Ventricular Assist Device

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Left ventricular assist device (LVAD) patients requiring heart transplantation (n=3336). Intervention: Donation after circulatory death (DCD) heart transplantation vs. Donation after brain death (DBD) heart transplantation. Primary outcome: Survival within the first year post-HT (aHR 1.00, 95% CI 0.70-1.42, p=> 0.9).

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Key result

DCD heart transplantation yields similar 1-year mortality to DBD in LVAD patients.

aHR 1.00
95% CI 0.70-1.42
P>0.9
n=3,336

Why the study?

Does heart transplantation using donation after circulatory death (DCD) maintain survival compared to donation after brain death (DBD) in adult patients with a left ventricular assist device (LVAD)?

Population

3,336 adult patients with a left ventricular assist device who underwent heart transplantation, median age…

Comparison

Heart transplantation using donation after… vs Heart transplantation using donation after brain…

Design

Cohort

Follow-up

1 year

Authors

AKAris KaratasakisUniversity of Washington ESE SilvestriPresbyterian Healthcare Services GNGatha NairRush University Medical Center

Discussion

Member takes

Implication

In LVAD patients, heart transplantation using donation after circulatory death yields similar 1-year survival to donation after brain death and facilitates earlier transplantation, though it is associated with higher rates of primary graft dysfunction and treated rejection.

Key Points

To compare early post-transplant survival and clinical outcomes between donation after circulatory death (DCD) and donation after brain death (DBD) heart transplants among patients with left ventricular assist devices (LVADs).
Retrospective cohort analysis using the United Network of Organ Sharing database for adult LVAD patients undergoing heart transplantation between October 17, 2018, and July 3, 2024 (N=3,336; 89% DBD, 11% DCD).
Assessed primary outcome of post-transplant survival within the first year alongside secondary in-hospital outcomes, rejection, and 1-year transplant likelihood.
Short-term post-transplant mortality showed no significant difference between DCD and DBD recipients (aHR 1.00, 95% CI 0.70–1.42, P > 0.9), while waitlisted patients at DCD-active centers had higher 1-year transplant rates (aHR 1.44, 95% CI 1.39–1.49, P < 0.001).
DCD recipients had significantly higher rates of primary graft dysfunction (aRR 3.8, 95% CI 2.5–5.7, P < 0.001) and treated rejection (aRR 1.48, 95% CI 1.14–1.93, P = 0.003), but stroke and dialysis-requiring acute kidney injury did not differ.

Study Design

Type

Cohort (n=3,336)

Multicenter

Yes

Structured PICO

Does heart transplantation using donation after circulatory death (DCD) maintain survival compared to donation after brain death (DBD) in adult patients with a left ventricular assist device (LVAD)?

Population

3,336 adult patients with a left ventricular assist device who underwent heart transplantation, evaluated for 1-year survival.

Exposure

Heart transplantation using donation after circulatory death (DCD)

Comparator

Heart transplantation using donation after brain death (DBD)

Outcome

Survival within the first year post-heart transplantationhard clinical

Main Result

Hazard Ratio: 1 (95% CI 0.7–1.42)

p-value: p=> 0.9

Cite This Study

Karatasakis et al. (2025) conducted a cohort in Left ventricular assist device (LVAD) patients requiring heart transplantation (n=3,336). Donation after circulatory death (DCD) heart transplantation vs. Donation after brain death (DBD) heart transplantation was evaluated on Survival within the first year post-HT (aHR 1.00, 95% CI 0.70-1.42, p=> 0.9). Heart transplantation using donation after circulatory death in LVAD patients was associated with similar 1-year mortality compared to donation after brain death (aHR 1.00; 95% CI 0.70-1.42; P>0.9).

synapsesocial.com/papers/6aa3c53922af0bded4f42db9 https://doi.org/10.1002/ehf2.15357

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Heart Transplantation Outcomes with Donation After Circulatory Death in Patients with Left Ventricular Assist Device

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Heart Transplantation Outcomes with Donation After Circulatory Death in Patients with Left Ventricular Assist Device

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

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