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Impact of Extended Travel Distances on Outcomes of Donation After Cardiac Death Heart Transplant Using Machine
Sooyun Caroline Tavolacci1,2, Ameesh Isath3, Gabrielle Amar4
1From the Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York.
Insights
Machine perfusion for donors after circulatory death heart transplants from extended distances shows comparable outcomes to shorter distances. However, longer cross-clamp to implantation times (>8 hours) are linked to worse survival, impacting donor and recipient selection.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Procurement
Background:
- Machine perfusion (MP) is a key technique for donors after circulatory death (DCD) heart transplants (HT).
- Limited data exist on MP use for DCD donors from extended distances (ED).
Purpose of the Study:
- To evaluate the outcomes of DCD heart transplants utilizing donors from extended distances (>500 miles) compared to shorter distances (≤500 miles).
Main Methods:
- Analysis of the United Network for Organ Sharing (UNOS) database for isolated DCD-HTs (Oct 2018-Dec 2023).
- Comparison of outcomes between control (≤500 miles) and extended distance (ED, >500 miles) groups.
- Propensity score matching was used to balance cohort characteristics (239 pairs).
Main Results:
- One-year survival was comparable between ED and control groups (91.8% vs. 92.4%, p=0.29).
- Extended donor travel distance was not associated with increased mortality (HR=0.81, p=0.51).
- Cross-clamp to implantation time >8 hours was significantly associated with increased mortality (HR=4.04, p=0.006).
Conclusions:
- DCD heart transplants using MP from extended distances demonstrate similar outcomes to those from shorter distances.
- Donor cross-clamp to implantation time exceeding 8 hours is a critical factor associated with worse patient survival.
- These findings suggest careful consideration of ischemic time in donor and recipient selection for DCD heart transplantation.
Abstract:
Machine perfusion (MP) is commonly used donors after circulatory death (DCD) heart transplants (HT) as direct procurement and perfusion technique, limited data exist regarding MP use for DCD donors from extended distances (ED). In the United Network for Organ Sharing (UNOS) database, 725 isolated DCD-HTs were identified between October 18, 2018, and December 31, 2023, excluding re-transplants and multi-organ transplants. Outcomes were compared according to travel distances: control (≤500 miles, n = 465) versus group ED (>500 miles, n = 260). Propensity score matching was performed (239 pairs). Travel distance was longer in group ED (224 [108-363] vs . 720 [576-903] miles; p < 0.001), as was time from cross-clamp to implantation (5.4 [3.8-6.3] vs . 6.8 [5.7-8] hours; p < 0.001). One year survival was comparable between groups (control, 92.4 ± 2.5% vs . group E, 91.8 ± 3.6%; p = 0.29). Extended distances donor was not associated with mortality (hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.43-1.53; p = 0.51). Cross-clamp-to-implantation time >8 hours was associated with mortality (reference: 0-4 hours; HR = 4.04; 95% CI = 1.50-10.86; p = 0.006), while 4-8 hours was not (HR = 1.35; 95% CI = 0.57-3.2; p = 0.497). In conclusion, DCD-HT with donors from ED using MP showed similar transplant outcomes compared with DCD-HT with donors within 500 miles. However, donor cross-clamp to implantation time >8 hours was associated with worse survival, which may be considered for donor and recipient selection.
