DCD Donor Hearts Recipients Compared to DBD Donor Heart Recipients Present with Comparable Systolic Left Ventricular Function and Better Myocardial Strain at 1 Year Follow Up

Abstract

Purpose Cardiac transplantation from donation after circulatory death (DCD) has been implemented at Papworth hospital since February 2015. Despite encouraging results some concerns may be raised about the impact of the warm ischemia and reperfusion injury on the myocardium status at longer follow-up. Therefore, we aimed to analyse systolic performance of the left ventricle at 1 year follow in DCD and donation after brain death (DBD) cardiac recipients, as assessed by echocardiography with myocardial deformation imaging. Methods We identified 26 DCD cardiac recipients who were transplanted from February 2015 to February 2017 and we matched them with 26 DBD cardiac recipients. Three and 2 patients from DCD and DBD group, respectively, died in the first-year post transplant. In the remaining patients we have compared the classical echocardiographic measurements as well as global longitudinal strain (GLS) and global circumferential strain (GCS) at 1-year follow-up. Results DCD and DBD patients did not present with differences in terms of classical echocardiographic parameters of left ventricular (LV) structure and systolic function. LVEDV was similar in DCD and DBD patients (102+/-37 vs. 99+/-21 ml, respectively), as well as LVESV (44+/-12 vs. 43 +/- 18 ml, respectively) and LV mass (157+/-36 vs. 169+/-44 gr). LV ejection fraction was similar in two groups (57+/- 7 vs. 58+/-8 %), as well as GLS (-15.9+/-2.3 vs. 14.8+/- 1.9%, p=0.1) and GCS (-23.7+/-5.7 vs. -20.3+/-4.1, p=0.05). In both groups 3 patients presented with left ventricular dysfunction secondary either to primary graft dysfunction or cellular rejection. When we limited analysis to the patients who presented at 1 year follow up with LVEF>=50%, DCD and DBD cardiac recipients presented with similar LVEF (60+/-5 vs. 58+/-4%), but DCD cardiac recipients in comparison to DBD recipients had better GLS (-16.5+/-1.7% vs. -15.1+/-1.4%, p=0.04) and better GCS (-25.2+/-4% vs. 20.9+/-3.25, p=0.02). Conclusion DCD and DBD cardiac recipients present with similar systolic LV function at 1-year follow, as assessed by classical echocardiographic parameters. DCD cardiac recipients have better myocardial deformation parameters as assessed by the speckle tracking in comparison to DBD cardiac recipients. Cardiac transplantation from donation after circulatory death (DCD) has been implemented at Papworth hospital since February 2015. Despite encouraging results some concerns may be raised about the impact of the warm ischemia and reperfusion injury on the myocardium status at longer follow-up. Therefore, we aimed to analyse systolic performance of the left ventricle at 1 year follow in DCD and donation after brain death (DBD) cardiac recipients, as assessed by echocardiography with myocardial deformation imaging. We identified 26 DCD cardiac recipients who were transplanted from February 2015 to February 2017 and we matched them with 26 DBD cardiac recipients. Three and 2 patients from DCD and DBD group, respectively, died in the first-year post transplant. In the remaining patients we have compared the classical echocardiographic measurements as well as global longitudinal strain (GLS) and global circumferential strain (GCS) at 1-year follow-up. DCD and DBD patients did not present with differences in terms of classical echocardiographic parameters of left ventricular (LV) structure and systolic function. LVEDV was similar in DCD and DBD patients (102+/-37 vs. 99+/-21 ml, respectively), as well as LVESV (44+/-12 vs. 43 +/- 18 ml, respectively) and LV mass (157+/-36 vs. 169+/-44 gr). LV ejection fraction was similar in two groups (57+/- 7 vs. 58+/-8 %), as well as GLS (-15.9+/-2.3 vs. 14.8+/- 1.9%, p=0.1) and GCS (-23.7+/-5.7 vs. -20.3+/-4.1, p=0.05). In both groups 3 patients presented with left ventricular dysfunction secondary either to primary graft dysfunction or cellular rejection. When we limited analysis to the patients who presented at 1 year follow up with LVEF>=50%, DCD and DBD cardiac recipients presented with similar LVEF (60+/-5 vs. 58+/-4%), but DCD cardiac recipients in comparison to DBD recipients had better GLS (-16.5+/-1.7% vs. -15.1+/-1.4%, p=0.04) and better GCS (-25.2+/-4% vs. 20.9+/-3.25, p=0.02). DCD and DBD cardiac recipients present with similar systolic LV function at 1-year follow, as assessed by classical echocardiographic parameters. DCD cardiac recipients have better myocardial deformation parameters as assessed by the speckle tracking in comparison to DBD cardiac recipients.