Abstract 13887: Longitudinal Trends in Donor and Recipient Risk Profile, and Clinical Outcomes, for Donation After Circulatory Death Heart Transplantation

Abstract

Background: The US rate of Donation after Circulatory Death (DCD) Heart Transplant (HT) increased threefold from 2020 to 2022. While early analyses of DCD HT have suggested similar outcomes compared to donation after brain death HT, this may be the result of a restrictive DCD donor and recipient selection process, intended to minimize risk in the first US DCD HT cohorts. Hypothesis: We hypothesized that risk profiles for DCD HT donors and recipients have increased over time, as DCD HT has rapidly expanded. We sought to identify longitudinal changes in risk profiles for DCD donors and recipients from 2019-2023, and determine if such changes have impacted post-DCD HT clinical outcomes. Methods: We analyzed the UNOS thoracic organ database from December 2019 to March 2023. DCD HT donor and recipient risk characteristics were evaluated over time for significant trend. One-year recipient survival was compared over time. Results: During the study period, 716 DCD HT were performed. Recipients were mostly male (79%), Caucasian (68%), and had mean age of 54 years. Over time, several donor and recipient characteristics were significantly different (Table, Figure). Donors were older, and had increased BMI, creatinine, and agonal phase to cross-clamp time, although overall lower ischemic time. Recipients were more likely to be status 1 or 2, and had increased BMI, waitlist time, creatinine, and CPRA. Donor and recipient comorbidities and mechanical support use were unchanged. Post-HT survival over time was unchanged. Conclusions: Since the first US DCD HT, several donor and recipient risk-factors have increased. These increased risk profiles have not translated into reduced one-year survival.