Related Experiment Video
Updated: Jun 6, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Severe primary graft dysfunction in heart transplant recipients using donor hearts after circulatory death: United
Peter D Cho1, Samuel T Kim2, Hedwig Zappacosta3
1Drexel University College of Medicine, Philadelphia, PA, USA.
Insights
Heart transplants from donors after circulatory death (DCD) show higher rates of severe primary graft dysfunction (PGD) initially. However, graft function improves by 72 hours, with similar long-term outcomes compared to brain death donors.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation Research
Background:
- Primary Graft Dysfunction (PGD) is a significant complication following heart transplantation.
- Donors after circulatory death (DCD) represent an increasing proportion of organ donors.
- Comparing outcomes between DCD and brain death (DBD) donors is crucial for optimizing heart transplant strategies.
Purpose of the Study:
- To compare the incidence of severe PGD in heart transplant recipients from DCD versus DBD donors.
- To evaluate graft dysfunction at 24 and 72 hours post-transplant based on donor type.
- To assess the impact of different DCD procurement methods on PGD rates.
Main Methods:
- Analysis of the United Network for Organ Sharing database for adult heart transplant recipients (9/2023-6/2024).
- Stratification of recipients by donor type (DCD vs. DBD) and DCD procurement method (Direct Procurement and Preservation vs. Normothermic Regional Perfusion).
- Comparison of severe PGD at 24 hours and severe graft dysfunction at 72 hours, along with 30-day mortality.
Main Results:
- DCD heart recipients were less likely to require inotropes or ECMO pre-transplant.
- Severe PGD (LV/BiV) at 24 hours was significantly higher in DCD recipients (9.5%) compared to DBD recipients (5.1%).
- Severe graft dysfunction at 72 hours and 30-day mortality were similar between DCD and DBD groups, irrespective of DCD procurement method.
Conclusions:
- Heart transplant recipients from DCD donors experience a higher incidence of severe PGD at 24 hours post-transplant.
- Graft dysfunction significantly improves by 72 hours in DCD recipients, leading to comparable long-term outcomes.
- Procurement methods for DCD hearts did not significantly alter early PGD rates.
Objective:
This study compares the incidence of severe Primary Graft Dysfunction (PGD) in a contemporaneous cohort of donors after circulatory death (DCD) and brain death (DBD) heart transplant recipients.
Method:
The United Network for Organ Sharing database was queried for isolated adult heart transplant recipients from 9/2023 to 6/2024. Heart recipients were stratified based on the organ donation type (DCD vs DBD). DCD heart recipients were further categorized based on the procurement method: time between circulatory death to cross-clamp: ≤ 30 minutes (Direct Procurement and Preservation, DPP), >30 minutes (Normothermic Regional Perfusion, NRP). Outcomes of interest included: severe PGD (Left/Bi-Ventricular; LV/BiV) at 24 hours and Severe Graft Dysfunction at 72 hours (patients with severe PGD at 24 hours that remain on mechanical support at 72 hours).
Results:
A total of 2590 adult heart transplant recipients were identified, of which 17.1% underwent DCD heart transplantation. DCD heart recipients were less likely to be on inotrope (36.7% vs 41.6%, p=0.046) and ECMO (4.1% vs 9.9%, p<0.001) prior to transplant than DBD heart recipients. DCD heart recipients were more likely than DBD heart recipients to develop severe PGD (LV/BiV) at 24 hours (9.5% vs 5.1%, p<0.001). The Severe Graft Dysfunction at 72 hours (2.3% vs 2.9%, p=0.67) and 30-day mortality were similar between the 2 groups. Recipients of DCD heart procured with DPP or NRP had similar severe PGD (LV/BiV) at 24 hours (9.4% vs 9.7%, p=0.93).
Conclusion:
Severe PGD at 24 hours is higher among the DCD than DBD heart recipients, but Graft Dysfunction improves by 72 hours.
