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Updated: May 5, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Survival after heart transplants from circulatory-dead versus brain-dead donors: Meta-analysis of reconstructed
Mohammed Al-Tawil1, William Wang2, Ashwini Chandiramani3
1Department of Cardiac and Thoracic Surgery, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA.
Insights
Heart transplantation using donors after circulatory death (DCD) shows similar early survival to donation after brain (DBD) recipients. However, DCD heart transplants demonstrate a trend toward lower long-term survival, becoming apparent around three years post-surgery.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Statistics
Background:
- Donation after circulatory death (DCD) heart transplantation (HTx) offers potential to increase organ availability.
- Comparing DCD HTx with donation after brain (DBD) HTx is crucial for understanding long-term outcomes.
Purpose of the Study:
- To reconstruct individual patient data from published Kaplan-Meier survival curves.
- To compare long-term survival rates between DCD and DBD heart transplant recipients.
Main Methods:
- Systematic literature search of MEDLINE, Embase, and Scopus databases.
- Digitization of Kaplan-Meier curves and reconstruction of individual patient data.
- Survival analysis using time-varying flexible parametric models and landmark analyses in R software.
Main Results:
- Analysis of six studies with 3240 patients (998 DCD, 2242 DBD).
- Initial analysis showed no significant difference in overall survival (HR: 1.01, P=0.91), but violated proportional hazard assumption.
- Time-varying models indicated significantly declining DCD recipient survival from 3 years post-surgery, with landmark analyses showing increased HR at 2 and 4 years.
Conclusions:
- DCD heart transplants exhibit similar early survival but a trend towards reduced long-term survival compared to DBD.
- The survival difference becomes statistically significant around three years post-transplantation.
- Enhanced post-transplant monitoring and care for DCD recipients are recommended; further long-term studies are needed.
Background:
Heart transplantation (HTx) using donors after circulatory death (DCD) has the potential to significantly boost overall transplant rates. This study aims to reconstruct data from individual studies comparing survival between HTx from DCD recipients and donation after brain (DBD) recipients.
Methods:
MEDLINE, Embase, Scopus, were searched up to August 2024. We included studies that reported a Kaplan-Meier summary of survival comparing DCD and DBD HTx. Digitization of the Kaplan-Meier curves and reconstruction of individual patient data followed by survival analysis that was conducted using R software.
Results:
Six studies including a total of 3240 patients (2242 DBD and 998 DCD) were included in the final analysis. There was no significant difference in the overall survival rates between DCD and DBD patients (Hazard Ratio (HR): 1.01, 95 % CI [0.81-1.25], P = 0.91). However, the proportional hazard assumption was violated, deeming such results inconclusive. Time-varying flexible parametric model revealed a significantly declining survival in DCD recipients 3 years after surgery. Landmark analyses further suggest this declining trend in the DCD group at the two-year landmark (HR: 1.67, p = 0.021) and the four-year mark (HR: 2.78, p = 0.002). However, data beyond 6 years is limited. Evidence comparing direct procurement and normothermic regional perfusion is scarce, with no significant survival differences observed.
Conclusion:
This meta-analysis shows that, despite similar early survival outcomes, DCD heart transplants showed a trend towards a lower long-term survival, with the difference becoming evident around three years post-transplantation. These findings highlight the need for enhanced monitoring and optimized post-transplant care in DCD recipients. Further studies with strict and long-term follow-up are warranted to confirm these results.
