Early Renal Outcomes Following Cardiac Transplantation Using Organs Procured after Circulatory Death

PurposeDemand for donor hearts persistently outstrips supply. To expand the donor pool, in the past four years, US centers have transplanted hearts procured from donors after circulatory death (DCD). DCD heart recipients frequently exhibit early, clinically significant, but reversible right ventricular dysfunction (RVD), but little is known about how this impacts post-transplant renal function. We evaluated whether DCD transplantation is associated with early renal dysfunction as compared to recipients receiving standard of care (SOC) hearts donated after brain death (DBD).MethodsAll patients at a single center who were not on dialysis and underwent single-organ cardiac transplantation from April 2016 to August 2022 were included. Renal metrics collected included final pre-transplantation creatinine and peak creatinine within seven days after transplantation; these were converted to eGFR using the CKD-Epi 2021 Race-Free GFR equation. Acute kidney injury (AKI) was defined as a 1.5-fold rise in creatinine within seven days. RA pressure was measured via right heart catheterization on day seven after transplant. Data were statistically analyzed with two-tailed t-tests, chi-squared tests, and Pearson's correlation coefficients, as appropriate.Results228 patients (171 SOC and 57 DCD) were included. Baseline characteristics were similar between groups. Nadir eGFR in the first week post-transplantation was similar between DCD and SOC (50.4 ± 28.0 mL/min vs 48.1 ± 25.8 mL/min; p=0.58), as were rates of AKI (49.1% vs 46.2%; p=0.92) and use of CVVH (7.0% vs 5.3%; p=0.89). DCD patients had higher RA pressures on day seven post-transplant (10.0 ± 4.2 mmHg vs 8.2 ± 4.7 mmHg for SOC; p=0.01); the inverse relationship between RA pressures and nadir post-transplantation eGFR in DCD patients was not significant (r=-0.25; p=0.07).ConclusionWhile transplantation using DCD hearts is associated with early RVD, no adverse impact on early renal outcomes compared to SOC recipients was observed. Demand for donor hearts persistently outstrips supply. To expand the donor pool, in the past four years, US centers have transplanted hearts procured from donors after circulatory death (DCD). DCD heart recipients frequently exhibit early, clinically significant, but reversible right ventricular dysfunction (RVD), but little is known about how this impacts post-transplant renal function. We evaluated whether DCD transplantation is associated with early renal dysfunction as compared to recipients receiving standard of care (SOC) hearts donated after brain death (DBD). All patients at a single center who were not on dialysis and underwent single-organ cardiac transplantation from April 2016 to August 2022 were included. Renal metrics collected included final pre-transplantation creatinine and peak creatinine within seven days after transplantation; these were converted to eGFR using the CKD-Epi 2021 Race-Free GFR equation. Acute kidney injury (AKI) was defined as a 1.5-fold rise in creatinine within seven days. RA pressure was measured via right heart catheterization on day seven after transplant. Data were statistically analyzed with two-tailed t-tests, chi-squared tests, and Pearson's correlation coefficients, as appropriate. 228 patients (171 SOC and 57 DCD) were included. Baseline characteristics were similar between groups. Nadir eGFR in the first week post-transplantation was similar between DCD and SOC (50.4 ± 28.0 mL/min vs 48.1 ± 25.8 mL/min; p=0.58), as were rates of AKI (49.1% vs 46.2%; p=0.92) and use of CVVH (7.0% vs 5.3%; p=0.89). DCD patients had higher RA pressures on day seven post-transplant (10.0 ± 4.2 mmHg vs 8.2 ± 4.7 mmHg for SOC; p=0.01); the inverse relationship between RA pressures and nadir post-transplantation eGFR in DCD patients was not significant (r=-0.25; p=0.07). While transplantation using DCD hearts is associated with early RVD, no adverse impact on early renal outcomes compared to SOC recipients was observed.