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Early Renal Outcomes Following Heart Transplantation Using Organs Procured After Circulatory Death.

Joyce C Zhou¹, Meghan E Sise², Kamila Drezek³

¹Department of Medicine Massachusetts General Hospital Boston MA USA.

Journal of the American Heart Association

|October 8, 2024

Summary

Heart transplantation using donation after circulatory death (DCD) organs shows similar short-term renal outcomes to donation after brain death (DBD) organs. Early acute kidney injury (AKI) in DCD recipients is linked to persistent kidney dysfunction.

Keywords:

acute kidney injury donation after circulatory death heart transplantation

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Area of Science:

Cardiovascular Surgery
Transplantation Medicine
Nephrology

Background:

The use of hearts from donation after circulatory death (DCD) donors is increasing in transplantation.
Limited data exist regarding the renal outcomes for recipients receiving DCD heart transplants.

Purpose of the Study:

To compare the short-term renal outcomes of heart transplant recipients who received organs from DCD donors versus donation after brain death (DBD) donors.

Main Methods:

A retrospective cohort study included 225 heart transplant recipients (55 DCD) between April 2016 and August 2022.
Renal outcomes assessed included estimated glomerular filtration rate (eGFR) at 1, 4, and 16 weeks post-transplant.
Incidence of acute kidney injury (AKI) and need for renal replacement therapy within the first week were analyzed.

Main Results:

Recipients of DCD hearts showed comparable renal outcomes to DBD recipients within the first week post-transplant.
Incidence of AKI (47.3% vs. 46.5%) and renal replacement therapy (3.6% vs. 4.7%) were similar between DCD and DBD groups.
DCD recipients with early AKI experienced persistent renal dysfunction at 16 weeks, unlike those without early AKI.

Conclusions:

Donation after circulatory death heart transplantation is associated with similar renal outcomes compared to donation after brain death.
The findings support the continued utilization of DCD organs for heart transplantation.
Early acute kidney injury is a significant predictor of persistent renal dysfunction in both DCD and DBD heart transplant recipients.