Improved Outcomes in Severe Primary Graft Dysfunction After Heart Transplantation Following Donation After Circulatory Death Compared With Donation After Brain Death
Related Experiment Video
Updated: Aug 22, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Austin Ayer1, Lauren K Truby1, Jacob N Schroder2
1Department of Medicine, Duke University School of Medicine, Durham, NC.
Insights
Donation after circulatory death (DCD) heart transplants show higher severe primary graft dysfunction (PGD) rates than donation after brain death (DBD). However, DCD recipients with PGD experience shorter recovery times, supporting DCD donor expansion.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Primary graft dysfunction (PGD) is a major cause of early mortality after heart transplantation.
- PGD is more prevalent in heart transplants from donation after circulatory death (DCD) donors compared to donation after brain death (DBD) donors.
Purpose of the Study:
- To compare the incidence, severity, and outcomes of PGD in heart transplant recipients following DCD versus DBD donation.
- To evaluate the impact of donor type on PGD development and patient recovery post-heart transplantation.
Main Methods:
- A retrospective cohort study analyzed adult heart transplant recipients from March 2016 to December 2021.
- PGD diagnosis within 24 hours post-transplant used modified International Society for Heart and Lung Transplant criteria.
- Data from 459 isolated heart transplantations (65 DCD, 394 DBD) were reviewed.
Main Results:
- The incidence of moderate or severe PGD was 34% in DCD recipients versus 23% in DBD recipients (P=0.070).
- DCD recipients had a higher likelihood of severe biventricular PGD (19% vs 7.4%; P=0.004).
- Despite higher PGD rates, DCD recipients with severe PGD had shorter mechanical circulatory support duration and hospital stays compared to DBD recipients.
Conclusions:
- DCD heart transplant recipients are more prone to severe biventricular PGD than DBD recipients.
- Patients receiving DCD hearts with severe PGD demonstrated improved recovery metrics, including reduced support duration and length of hospital stay.
- Findings support the use of DCD donors to expand the heart donor pool, suggesting distinct graft dysfunction and recovery patterns based on donor type.
Background:
Primary graft dysfunction (PGD), the leading cause of early mortality after heart transplantation, is more common following donation after circulatory death (DCD) than donation after brain death (DBD). We conducted a single-center, retrospective cohort study to compare the incidence, severity and outcomes of patients experiencing PGD after DCD compared to DBD heart transplantation.
Methods And Results:
Medical records were reviewed for all adult heart transplant recipients at our institution between March 2016 and December 2021. PGD was diagnosed within 24 hours after transplant according to modified International Society for Heart and Lung Transplant criteria. A total of 459 patients underwent isolated heart transplantation during the study period, 65 (14%) following DCD and 394 (86%) following DBD. The incidence of moderate or severe PGD in DCD and DBD recipients was 34% and 23%, respectively (P = 0.070). DCD recipients were more likely to experience severe biventricular PGD than DBD recipients (19% vs 7.4%; P = 0.004). Among patients with severe PGD, DCD recipients experienced shorter median (Q1, Q3) duration of post-transplant mechanical circulatory support (6 [4, 7] vs 9 [5, 14] days; P = 0.039), shorter median post-transplant hospital length of stay (17 [15, 29] vs 52 [26, 83] days; P = 0.004), and similar 60-day survival rates (100% [95% CI: 76.8%-100%] vs 80.0% [63.1%-91.6%]; P = 0.17) and overall survival (log-rank; P = 0.078) compared with DBD recipients.
Conclusions:
DCD heart transplant recipients were more likely to experience severe, biventricular PGD than DBD recipients. Despite this, DCD recipients with severe PGD spent fewer days on mechanical circulatory support and in the hospital than similar DBD patients. These findings suggest that patterns of graft dysfunction and recovery may differ between donor types, and they support the expansion of the heart-donor pool with DCD.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...