TY - JOUR
T1 - Feasibility and Potential Impact of Heart Transplantation From Adult Donors After Circulatory Death
AU - Madan, Shivank
AU - Saeed, Omar
AU - Forest, Stephen J.
AU - Goldstein, Daniel J.
AU - Jorde, Ulrich P.
AU - Patel, Snehal R.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/1/18
Y1 - 2022/1/18
N2 - Background: A shortage of donation after brain death (DBD) donors for heart transplantation (HT) persists. Recent improvements in organ procurement from donation after circulatory death (DCD) donors and promising early results of DCD-HTs from Europe and Australia have renewed interest in DCD-HT. Objectives: The current study evaluated donor and recipient characteristics, early outcomes, and potential impact of adult DCD-HT in the United States. Methods: The United Network for Organ Sharing registry was used to identify and compare adult DCD donors based on their use for HT between January 2020 and February 2021. Adult DCD-HTs with available post-HT outcomes data were compared with contemporary adult DBD-HTs during study period using Cox-regression analysis and propensity-matching. Results: Of the 3,611 adult DCD donors referred during the study period, 136 were used for HT. DCD donors used for HT were younger (median age 29 years), and most were male (90%), and blood type O (79%). On comparing DCD-HT (n = 127) and DBD-HT (n = 2,961) meeting study criteria and with available data on post-HT outcomes, there was no significant difference in 30-day or 6-month mortality, primary graft failure up to 30 days, or other outcomes including in-hospital stroke, pacemaker insertion, hemodialysis, and post-HT length of hospital stay. Results were similar in propensity matched DCD-HT and DBD-HT cohorts. The number of potential adult DCD donors referred has increased substantially (n = 871 in 2010 to n = 3,045 in 2020), and the authors estimated that widespread adoption of DCD-HT could lead to approximately 300 additional adult HTs in the United States annually. Conclusions: This preliminary analysis of adult DCD-HTs from the United States showed favorable early outcomes and suggested a potential for substantial increase in adult HT volumes with use of DCD donors.
AB - Background: A shortage of donation after brain death (DBD) donors for heart transplantation (HT) persists. Recent improvements in organ procurement from donation after circulatory death (DCD) donors and promising early results of DCD-HTs from Europe and Australia have renewed interest in DCD-HT. Objectives: The current study evaluated donor and recipient characteristics, early outcomes, and potential impact of adult DCD-HT in the United States. Methods: The United Network for Organ Sharing registry was used to identify and compare adult DCD donors based on their use for HT between January 2020 and February 2021. Adult DCD-HTs with available post-HT outcomes data were compared with contemporary adult DBD-HTs during study period using Cox-regression analysis and propensity-matching. Results: Of the 3,611 adult DCD donors referred during the study period, 136 were used for HT. DCD donors used for HT were younger (median age 29 years), and most were male (90%), and blood type O (79%). On comparing DCD-HT (n = 127) and DBD-HT (n = 2,961) meeting study criteria and with available data on post-HT outcomes, there was no significant difference in 30-day or 6-month mortality, primary graft failure up to 30 days, or other outcomes including in-hospital stroke, pacemaker insertion, hemodialysis, and post-HT length of hospital stay. Results were similar in propensity matched DCD-HT and DBD-HT cohorts. The number of potential adult DCD donors referred has increased substantially (n = 871 in 2010 to n = 3,045 in 2020), and the authors estimated that widespread adoption of DCD-HT could lead to approximately 300 additional adult HTs in the United States annually. Conclusions: This preliminary analysis of adult DCD-HTs from the United States showed favorable early outcomes and suggested a potential for substantial increase in adult HT volumes with use of DCD donors.
KW - DBD
KW - DCD
KW - donation after brain death
KW - donation after circulatory death
KW - heart transplantation
KW - transplant outcomes
UR - http://www.scopus.com/inward/record.url?scp=85121899740&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85121899740&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2021.10.042
DO - 10.1016/j.jacc.2021.10.042
M3 - Article
C2 - 34922742
AN - SCOPUS:85121899740
SN - 0735-1097
VL - 79
SP - 148
EP - 162
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 2
ER -