Results of Heart Transplants from Donation After Circulatory Death (DCD) Donors Using Thoraco-Abdominal Normothermic Regional Perfusion (TA-NRP) Compared to Donation After Brain Death (DBD)

Abstract

<h3>Purpose</h3> In the U.S., heart transplantation from donation after circulatory death (DCD) is increasing. We present our institutional experience of DCD transplantation by using a thoracoabdominal-normothermic regional perfusion (TA-NRP) protocol and compare the results to a cohort concomitantly transplanted, from standard brain death (DBD) donation. <h3>Methods</h3> For TA-NRP protocol, suitable local DCD donors were transferred to our institution and co-located with the recipient in proximate operating rooms. Standard DCD procurement involved resuscitation of the donor on cardiopulmonary bypass after declaration of death and assessment for suitability by echocardiogram and hemodynamic data. Heart transplant from DBD was performed per standard protocol. Immunosuppression and management followed the same standardized protocol for all recipients. <h3>Results</h3> Between January 2020 and October 2021, we performed 10 DCD transplantations with TA-NRP protocol (7 isolated heart, 2 heart-lung and 1 heart-kidney). The median age was 54 years (44-72), and 70% were male. One heart-lung transplant recipient required VA ECMO post-op, for 3 days. During the same period, 70 patients received heart transplant from a DBD donor (71.4% isolated heart, 7.1% heart-lung, 21.4% heart-kidney). The median age was 56 years (24-77) - p=0.916, 84.% were male p=0.27. At mean follow-up of 397.6 days (DCD recipients) and 305.9 days (DBD recipients), there were no significant differences in acute cellular, antibody mediated rejection, cardiac allograft vasculopathy, heart graft function, and survival. Compared to DBD recipients, DCD recipients received transplant at lower listed statuses. <h3>Conclusion</h3> Short-term results suggest that transplant outcomes from DCD TA-NRP are comparable to recipients from DBD. Expanding heart transplantation by using DCD is a viable option for lower-status listed patients and wide adoption should be considered.