Abstract
In the setting of the obesity epidemic and donor organ shortage in the United States, there's a growing need to expand the donor organ eligibility criteria for orthotopic heart transplantation (OHT). Donation after circulatory death (DCD) has emerged as a promising solution, but the outcomes with obese donor hearts in DCD remains unknown. Using the UNOS registry between 2019 and 2024, recipients of DCD OHT were stratified into three donor obesity categories by body mass index (BMI): underweight/normal (BMI <25kg/m2), overweight (BMI 25-30kg/m2), and obese (BMI >30kg/m2). These cohorts were sub-grouped by organ procurement strategies: direct procurement and preservation (DPP) and normothermic regional perfusion (NRP). Recipient and donor characteristics, and risk factors for mortality were analyzed using Cox regression hazard models. Survival at 30-days, 1-, and 5-years were analyzed using the Kaplan-Meier method. We found no significant differences in patient and graft survival between donor BMI categories at all time points. Among recipients of overweight (HR 0.38; p=0.0371) and obese (HR 0.24; p=0.0493) donor hearts, NRP was associated with decreased risk of mortality. Donor-recipient predicted heart-mass (PHM) undermatching (defined as <86%) was associated with increased risk of mortality among underweight/normal weight (HR 1.28; p=0.0323) and overweight (HR 1.08; p=0.0382) donors. Donor obesity does not confer increased risk of recipient mortality in DCD OHT, particularly when utilizing NRP. PHM undermatching continues to be associated with adverse outcomes in DCD OHT.
Published Version
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