DCD; Donor; Heart transplant; PGD; Recipient; Regional-differences; Surgery; Pulmonary and Respiratory Medicine; Cardiology and Cardiovascular Medicine; Transplantation
Abstract :
[en] [en] BACKGROUND: Donation after the circulatory determination of death (DCD) heart transplantation (HT) is becoming more widely adopted across the United States (US) and Europe.
OBJECTIVE: This study compared donor and recipient demographics, intraoperative parameters, and outcomes between DCD HT centers in Europe and the US that contributed to the Outcomes after DCD Cardiac Transplantation Database.
METHODS: This was a retrospective observational study across 22 HT centers in Belgium, Spain, the United Kingdom (UK), and the US. All patients undergoing DCD HT at participating centers, from the start of each center's DCD program through 01/01/2023, were included with censor date 01/01/2024. The primary outcome was 1-year survival. Secondary outcomes included severe primary graft dysfunction and incidence of acute cellular rejection.
RESULTS: Data from 223 patients in Europe and 281 in the US were analyzed. DCD donors in Europe were significantly older (37 years vs 28 years; p < 0.001). Recipients in Europe had inferior 1-year survival (86.6% vs 91.8%; p = 0.043), but 1-month and 3-years survival were similar. 1-year survival in the direct procurement and preservation (DPP) cohort was significantly higher in the US group (91.2% vs 82.6%; p = 0.02). In the thoraco-abdominal normothermic regional perfusion (taNRP) cohort 1-year survival was similar between Europe and the US. Recipients in Europe had higher use of mechanical circulatory assist post-transplant (17.9% vs 11%; p = 0.03).
CONCLUSION: This study further confirms the safety and efficacy of DCD HT across centers in the US and Europe, despite important differences in donor and recipient demographics and clinical outcomes. Continued collection of international data may identify opportunities to improve outcomes.
Disciplines :
Cardiovascular & respiratory systems Surgery
Author, co-author :
Louca, John O; Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom, Royal Papworth Hospital, Cambridge, United Kingdom,, John Radcliffe Hospital, Oxford, United Kingdom. Electronic address: jol20@cam.ac.uk
Öchsner, Marco; Royal Papworth Hospital, Cambridge, United Kingdom,, LMU University Hospital Munich, Munich, Germany
Shah, Ashish; Vanderbilt University Medical Center, Nashville, TN
Schlendorf, Kelly; Vanderbilt University Medical Center, Nashville, TN
Lima, Brian ; Vanderbilt University Medical Center, Nashville, TN
Wang, Chen Chia ; Vanderbilt University Medical Center, Nashville, TN
Siddiqi, Hasan ; Vanderbilt University Medical Center, Nashville, TN
Irshad, Ali; Vanderbilt University Medical Center, Nashville, TN
Schroder, Jacob; Duke University Medical Center, Durham, NC
Casalinova, Sarah ; Duke University Medical Center, Durham, NC
Milano, Carmelo; Duke University Medical Center, Durham, NC
Khush, Kiran K ; Stanford University, Stanford, CA
Skoda, Anette; Stanford University, Stanford, CA
Luikart, Helen; Stanford University, Stanford, CA
Ashley, Euan; Stanford University, Stanford, CA
Moazami, Nader ; NYU Langone Health, New York, NY
James, Les; NYU Langone Health, New York, NY
Dar, Owais; Harefield Hospital (A Division of Guys and St Thomas' NHS Foundation Trust), London, United Kingdom, School of Cardiovascular Medicine & Sciences Kings College London, London, United Kingdom
Konicoff, Mailen; Harefield Hospital (A Division of Guys and St Thomas' NHS Foundation Trust), London, United Kingdom
Urban, Marian ; Medical Center, University of Nebraska, Omaha, NE
Um, John ; Medical Center, University of Nebraska, Omaha, NE
Castleberry, Anthony ; Medical Center, University of Nebraska, Omaha, NE
Hoffman, Jordan R H ; Anschutz Medical Center, University of Colorado, Aurora, CO
Cain, Michael T; Anschutz Medical Center, University of Colorado, Aurora, CO
Fetten, Katharina; Baylor Scott and White Health, Baylor University Medical Center, Dallas, TX
Meyer, Dan ; Baylor Scott and White Health, Baylor University Medical Center, Dallas, TX
Xu, Addison ; Baylor Scott and White Health, Baylor University Medical Center, Dallas, TX
González-Vilchez, Francisco; Hosp Marques de Valdecilla, Santander, Spain
Domínguez-Gil, Beatriz; Organización Nacional de Trasplantes, Madrid, Spain
Royo-Villanova, Mario ; Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Garrido, Iris; Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Cánovas, Sergio J; Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Brouckaert, Janne ; University Hospitals Leuven, Leuven, Belgium
Vandendriessche, Katrien ; University Hospitals Leuven, Leuven, Belgium
Rega, Filip ; University Hospitals Leuven, Leuven, Belgium
Tchana-Sato, Vincent ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire
Berman, Marius; Royal Papworth Hospital, Cambridge, United Kingdom
Bae, James; Royal Papworth Hospital, Cambridge, United Kingdom
Asemota, Nicole; Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom, Royal Papworth Hospital, Cambridge, United Kingdom
Sinha, Sanjay; Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
Pettit, Stephen ; Royal Papworth Hospital, Cambridge, United Kingdom
Messer, Simon; Golden Jubilee National Hospital, Glasgow, United Kingdom
Large, Stephen; Royal Papworth Hospital, Cambridge, United Kingdom
Bhagra, Sai ; Royal Papworth Hospital, Cambridge, United Kingdom
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