Related Experiment Video
Updated: May 21, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Outcomes of Donation After Circulatory Death Heart Transplantation Using Normothermic Regional Perfusion
Akshay Kumar1, Amit Alam2, Michael Dorsey1
1Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
Insights
Heart transplants using donation after circulatory death (DCD) with thoracoabdominal normothermic regional perfusion (TA-NRP) show promising 1-year survival. This approach demonstrates acceptable rates of graft dysfunction, rejection, and cardiac allograft vasculopathy.
Area of Science:
- Cardiology
- Transplantation Surgery
- Immunology
Background:
- Donation after circulatory death (DCD) heart transplantation utilizes cardiopulmonary bypass for thoracoabdominal normothermic regional perfusion (TA-NRP), increasing donor heart availability.
- Long-term outcomes and rejection rates following DCD heart transplantation remain largely unknown.
Purpose of the Study:
- To evaluate the outcomes of DCD heart transplantation using TA-NRP.
- To assess 1-year survival, primary graft dysfunction (PGD), cardiac allograft vasculopathy (CAV), and rejection rates.
Main Methods:
- A single-center retrospective cohort review of 32 DCD heart transplant recipients from January 2020 to December 2023.
- Analysis of donor/recipient characteristics, operative details, and post-transplant outcomes, including a subgroup analysis of co-localized versus distant donors/recipients.
- The TA-NRP protocol involved sternotomy, aortic arch vessel ligation, cardiopulmonary bypass, reintubation, cardiac resuscitation, and cold static storage.
Main Results:
- One-year survival was 100% among the 32 DCD heart transplant recipients.
- Two patients experienced primary graft dysfunction requiring mechanical support; four had grade 2R acute cellular rejection; five developed grade 1 CAV at 1 year.
- Distant donors and recipients experienced longer warm and cold ischemia times without other significant differences.
Conclusions:
- DCD heart transplantation with TA-NRP yields encouraging 1-year outcomes.
- Acceptable rates of rejection, PGD, CAV, and overall survival are observed with this approach.
Background:
Donation after circulatory death (DCD) with cardiopulmonary bypass for thoracoabdominal normothermic regional perfusion (TA-NRP) has led to increased use of donor hearts. Rejection rates and long-term survival outcomes are not known.
Methods:
A single-center retrospective cohort review of patients who underwent DCD heart transplantation from January 2020 to December 2023 was performed. Donor and recipient characteristics, operative characteristics, and posttransplantation outcomes were analyzed. Subgroup analysis comparing co-localized vs distant donors and recipients was performed. The primary end point was 1-year survival. Secondary end points included incidences of primary graft dysfunction (PGD), cardiac allograft vasculopathy (CAV), rejection rate, and overall mortality. Our TA-NRP protocol has remained the same, consisting of sternotomy, ligation of aortic arch vessels, establishment of cardiopulmonary bypass, reintubation, resuscitation of the heart, and cold static storage during transport.
Results:
In total, 32 recipients underwent DCD heart transplantation, including 26 isolated hearts, 3 heart-lungs, and 3 heart-kidneys. The median age was 56 years for recipients and 39 years for donors; 21 donors and recipients were co-localized, whereas 11 were distant. One-year survival was 100%. Two patients required mechanical circulatory support for PGD. Four patients experienced grade 2R acute cellular rejection. Five patients had grade 1 CAV at 1 year. On subgroup analysis, distant donors and recipients had longer warm (47 vs 30 minutes; P < .005) and cold (213 vs 76 minutes; P < .005) ischemia times, without any other differences.
Conclusions:
Outcomes after DCD heart transplantation using TA-NRP remain encouraging with acceptable rates of rejection, PGD, CAV, and survival at 1 year.
