Heart Transplantation from Donors after Circulatory Death in Patients Supported by Left Ventricular Assist Devices

PurposeHeart transplantation utilizing Donation after Circulatory Death (DCD) donors are increasing but data remain limited. We sought to evaluate heart transplant survival and outcomes of LVAD patients transplanted with DCD donor hearts in a large national registry.MethodsUsing the United Network for Organ Sharing (UNOS) database, adult patients ≥ 18 years old listed for heart transplantation from 1/1/2019 - 12/31/2021 and supported with an LVAD were evaluated. Patients were categorized in DBD (donation after brain death) and DCD groups. Recipient and donor characteristics at the time of transplant and post-transplant outcomes were compared between groups.ResultsOf 2281 LVAD patients, the majority (96%, N=2179) were transplanted with DBD donors and 102 patients transplanted with DCD donors. In the DCD group, the most common recipient blood type was O (66%). Compared to the no-DCD group, DCD LVAD patients were most commonly transplanted at UNOS status 4 (55.88%) and had shorter days on the wait list (114 vs. 200 days). The one-year heart transplant survival was not statistically different in LVAD patients transplanted with DCD donors compared with no-DCD donors (92% vs. 90%; p=0.5, Figure). There were more episodes of acute rejection (31% vs. 19%; p=0.004) without differences in graft failure (p=0.281) or frequency of re-transplantation between the DCD compared to the no-DCD group (p=0.338). The DCD group had a significant reduction in hospital length of stay following transplant (18.82 days vs. 23.97 days, p=0.034) and shorter travel distance to the transplant center (419.8 vs. 237.1 nautical miles, p<0.001). Propensity analysis demonstrates no significant difference in one year post transplant survival in LVAD patients transplanted with no-DCD or DCD donors (p=0.54).ConclusionHeart transplant survival and outcomes for LVAD patients utilizing DCD donor hearts are favorable. This data supports continued use of DCD donor hearts for LVAD patients listed for heart transplant. Heart transplantation utilizing Donation after Circulatory Death (DCD) donors are increasing but data remain limited. We sought to evaluate heart transplant survival and outcomes of LVAD patients transplanted with DCD donor hearts in a large national registry. Using the United Network for Organ Sharing (UNOS) database, adult patients ≥ 18 years old listed for heart transplantation from 1/1/2019 - 12/31/2021 and supported with an LVAD were evaluated. Patients were categorized in DBD (donation after brain death) and DCD groups. Recipient and donor characteristics at the time of transplant and post-transplant outcomes were compared between groups. Of 2281 LVAD patients, the majority (96%, N=2179) were transplanted with DBD donors and 102 patients transplanted with DCD donors. In the DCD group, the most common recipient blood type was O (66%). Compared to the no-DCD group, DCD LVAD patients were most commonly transplanted at UNOS status 4 (55.88%) and had shorter days on the wait list (114 vs. 200 days). The one-year heart transplant survival was not statistically different in LVAD patients transplanted with DCD donors compared with no-DCD donors (92% vs. 90%; p=0.5, Figure). There were more episodes of acute rejection (31% vs. 19%; p=0.004) without differences in graft failure (p=0.281) or frequency of re-transplantation between the DCD compared to the no-DCD group (p=0.338). The DCD group had a significant reduction in hospital length of stay following transplant (18.82 days vs. 23.97 days, p=0.034) and shorter travel distance to the transplant center (419.8 vs. 237.1 nautical miles, p<0.001). Propensity analysis demonstrates no significant difference in one year post transplant survival in LVAD patients transplanted with no-DCD or DCD donors (p=0.54). Heart transplant survival and outcomes for LVAD patients utilizing DCD donor hearts are favorable. This data supports continued use of DCD donor hearts for LVAD patients listed for heart transplant.