Outcomes of Heart Transplantation From Donation After Circulatory Death: An Up-to-date Systematic Meta-analysis

Area of Science:

• Cardiology
• Transplantation Surgery
• Medical Research

Background:

• Donation after circulatory death (DCD) heart transplantation (HTx) expands the donor pool and reduces waitlist mortality.
• Limited high-level evidence exists on the safety and effectiveness of DCD HTx.
• This meta-analysis compares outcomes between DCD and donation after brain death (DBD) HTx.

Purpose of the Study:

• To compare the safety and effectiveness of DCD heart transplantation versus DBD heart transplantation.
• To evaluate mortality rates and other outcomes in DCD and DBD heart transplant recipients.

Main Methods:

• Systematic search of MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials for studies from 2014 onwards.
• Inclusion of randomized controlled trials and observational studies reporting DCD and DBD HTx outcomes.
• Meta-analysis using random-effects models, with risk ratios (RRs) and mean differences for outcome measures.

Main Results:

• Twelve studies were included in the meta-analysis.
• DCD HTx demonstrated a significantly lower 1-year mortality rate (8.13% vs. 10.24%) compared to DBD HTx (RR=0.75, P=0.02).
• DCD HTx also showed a lower 5-year mortality rate (14.61% vs. 20.57%) compared to DBD HTx (RR=0.72, P=0.03).

Conclusions:

• DCD heart transplantation is a promising alternative to DBD transplantation under current criteria.
• The safety and feasibility of utilizing DCD hearts warrant further investigation.
• Evidence suggests DCD hearts can achieve favorable short- and medium-term outcomes.