Outcomes After Donation After Circulatory Determination of Death Cardiac Transplantation

BACKGROUND: As donation after circulatory determination of death (DCD) heart transplantation (HT) becomes more widely adopted, there is a need to establish the most clinically effective method of organ procurement. OBJECTIVES: This international, multicenter study compares outcomes of DCD HT across Europe and the United States between recipients whose donor hearts were retrieved using thoraco-abdominal normothermic regional perfusion (taNRP) with those whose hearts were recovered using direct procurement and perfusion (DPP). METHODS: This was a retrospective observational study across 22 heart transplant centers in Belgium, Spain, the United Kingdom, and the United States. This study included all patients undergoing DCD HT at participating centers, from the start of each center's DCD program through January 1, 2023. DCD HT with recovery using either taNRP or DPP were compared with one another. Posttransplant outcomes included: 1) survival at 1 year; 2) incidence of severe primary graft dysfunction (PGD); and 3) episodes of treated, biopsy-proven acute-cellular rejection (ACR) in the first year following transplantation. RESULTS: A total of 504 DCD HTs took place in the study period. Survival at 1 year was similar for taNRP and DPP recipients (91% vs 88%; P = 0.100). taNRP recipients had a lower rate of severe PGD (7.6% vs 19.2%; P < 0.001) and fewer episodes of biopsy-proven, ACR requiring treatment in the first year post-transplantation (13% vs 25%; P < 0.001). CONCLUSIONS: In an international study of DCD HT, recipients of hearts retrieved by taNRP technique had lower rates of severe PGD and fewer episodes of biopsy-proven ACR in the first year when compared with those retrieved by using DPP. These results should be further investigated with randomized control trials.