Heart Transplant Outcomes with Donation After Cardiac Death: UNOS Registry Analysis

Abstract

<h3>Purpose</h3> Limitations in organ donation have led to approaches to expand the existing donor pool. Donation after cardiac death (DCD) has continued to increase after efforts led by the United Kingdom and Australia. We sought to describe the United States experience. <h3>Methods</h3> 5153 heart transplant (HT) recipients were identified in the UNOS Registry between 1/2019 and 6/2021, of which 229 were DCD recipients. HT recipients were grouped by DCD status or donation after brain death (DBD). Comparisons between groups were assessed using standard statistical methods, survival analysis was censored at 12-months via the Kaplan-Meier method. Multivariate Cox proportional hazard regression analysis (adjusted for age, sex, diabetes, race, ischemic time, dialysis, life support, waiting time & HLA mismatch) were performed. <h3>Results</h3> Recipients of DCD donors were of lower UNOS status (p<0.001), increased VAD use (p=0.01), and less dialysis (p=0.011). Additionally, DCD donor recipients had longer wait times (46.0 vs 30.0d, p=0.007), longer ischemic times (p<0.001) but younger donors (29.8 vs 23.4y, p<0.001). There was no difference in 1-month or 1-year survival by donor type (p=0.720). Unadjusted analysis demonstrated HR 0.91 (0.52-1.57) and following adjustment HR 0.88 (0.48-1.61). <h3>Conclusion</h3> Short-term survival of DCD donors is similar to DBD donors in this UNOS Registry analysis. DCD donor use has potential to expand the donor pool. Further study is warranted to assess longer term outcomes as well as best strategies for donation.