187. Five-Year Experience of Heart Transplantation Following Donation After Circulatory Death: Outcomes from a Large Tertiary Center

Objective: The United States experience with heart transplantation following donation after circulatory death (DCD HT) has expanded since clinical adoption in 2019. The aim of this study was to examine a large institution's outcomes associated with DCD HT vs HT following donation after brain death (DBD).
Methods: A single-center retrospective observational cohort study was conducted. All adult (age > 18 years) heart recipients and corresponding donors of both DBD and DCD HT from January 2019 to October 2024 were included. Recipient and donor data were extracted from the institution's electronic medical record and the United Network for Organ Sharing registry, respectively. DCD HT allografts were retrieved with either direct procurement and perfusion or normothermic regional perfusion techniques. The primary outcome was overall survival.
Results: During the study period, a total of 553 heart donors and recipients met inclusion criteria, including 404 (73%) DBD and 149 (27%) DCD recipients. Donors of DCD allografts were more likely male than DBD donors (p<0.001). Recipients of DCD allografts were more likely to have a left ventricular assist device (LVAD) prior to transplant (p=0.011), but there was no significant difference in waitlist status at the time of transplant between the two groups. DCD allografts had increased ischemic time (5.7 hours vs 3.7 hours; p<0.001) and distance to travel (381 miles vs 299 miles; p=0.001) compared to DBD allografts. Unadjusted Kaplan-Meier survival analysis demonstrated no significant difference between DCD and DBD recipients' cumulative survival (log-rank p=0.15, Figure). One-year survival was 91% (95% CI: 86-96%) among DCD recipients compared with 90% (95% CI: 88-94%) among DBD recipients. The rate of severe primary graft dysfunction (PGD) requiring veno-arterial extracorporeal membrane oxygenation was not significantly different between groups (11% DCD vs 10% DBD; p=0.877). Additionally, the incidence of acute rejection prior to hospital discharge was lower in DCD recipients (16% vs 25%; p=0.043). There was no difference in hospital length of stay or post-transplant renal function between the DCD and DBD recipients.
Conclusions: Cardiac allografts from DCD donors perform similarly to a contemporary population of DBD allografts. Despite increased ischemic time of DCD allografts, the rate of severe PGD and the unadjusted cumulative survival were not significantly different between DCD and DBD recipient groups.

Abigail Benkert (1), Oliver Jawitz (1), Alejandro Alvarez (1), Krish Dewan (1), Chetan Patel (1), Adam DeVore (1), Jacob Schroder (1), Carmelo Milano (1), Jeffrey Keenan (1), (1) Duke University Medical Center, Durham, NC

William Hiesinger

Commentator

William Hiesinger is the surgical director of the LVAD/Mechanical Circulatory Support, Hypertrophic Cardiomyopathy Center, and CTEPH programs at Stanford University. He also serves as the program director for the Transplant/MCS fellowship. His practice encompasses the full spectrum of cardiothoracic surgery including transplantation, valvular repair, complex aortic surgery, and coronary revascularization with a focus on high risk and heart failure patients. Dr. Hiesinger's research group spans the disciplines of computer science and cardiovascular biology and builds novel foundational deep learning systems designed to better represent and process high-dimensional inputs and apply these systems towards clinical problems. Based on this work, he was awarded an NIH R01 grant (HL157235-01A1 “Radiomics approach to engineering an artificial intelligence based echocardiography platform to predict cardiovascular surgery and heart failure outcomes”). This research has yielded senior author publications in journals including Nature Communications, Nature Machine Intelligence, JHLT, and Circulation Heart Failure.

Abigail Benkert

Abstract Presenter

Abigail Benkert is originally from Littleton, Colorado. She completed her undergraduate studies at Franklin and Marshall College, where she majored in Neuroscience. She then worked as a research fellow and laboratory scientist at the Clinic for Special Children (CSC), a pediatric medical genetics clinic that diagnoses and treats inherited disorders among the Amish and Mennonite populations. Following her time at CSC, Abby attended medical school at Tufts University School of Medicine - Maine Track. She is now a 5th year surgical resident in Duke University School of Medicine's Integrated Cardiothoracic surgical residency.