Related Experiment Video
Updated: Sep 13, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Potential intermediate-term survival differences among heart transplant recipients from circulatory death vs brain
Anh Nguyen1, Abbas Rana2, Alexis Shafii1
1Division of Cardiothoracic Transplantation and Circulatory Support, Department of Surgery, Baylor College of Medicine, Houston, Texas.
Insights
Heart transplant survival rates from donation after circulatory death (DCD) donors may be lower than donation after brain death (DBD) donors, particularly after the first year. Further research is needed to understand these differences in DCD heart transplants.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Comparing outcomes of heart transplantation using organs from donation after circulatory death (DCD) versus donation after brain death (DBD) donors.
- Utilizing the United Network for Organ Sharing (UNOS) database for comprehensive analysis.
- Extending follow-up to three years post-transplant to assess intermediate-term survival.
Purpose of the Study:
- To evaluate and compare the intermediate-term survival rates of heart transplant recipients who received organs from DCD donors versus DBD donors.
- To identify potential disparities in survival outcomes between DCD and DBD heart transplant recipients.
Main Methods:
- Retrospective cohort study using the UNOS database (January 2019 - June 2024).
- Inclusion of 1,453 DCD and 16,561 DBD adult heart transplants.
- 1-to-1 propensity-score matching to create balanced cohorts for analysis.
- Survival analysis using Cox regression and Kaplan-Meier curves.
Main Results:
- In the overall cohort, no significant difference in mortality was observed between DCD and DBD heart transplants.
- After propensity-score matching, DCD heart transplant recipients showed a trend towards higher mortality (HR 1.2).
- While year 1 survival was similar, DCD recipients had significantly lower survival rates in years 2 and 3 compared to DBD recipients.
Conclusions:
- Intermediate-term survival following DCD heart transplantation may be lower compared to DBD transplantation.
- Significant survival differences emerge in the second and third years post-transplant.
- Further investigation is warranted to identify factors contributing to potential disparities in DCD heart transplant outcomes.
Background:
This study builds upon previous analyses by examining heart transplant survival from donation after circulatory death (DCD) vs donation after brain death (DBD) using the United Network for Organ Sharing (UNOS) database, with follow-up extended to 3 years post-transplant.
Methods:
We conducted a retrospective cohort study of 1,453 DCD and 16,561 DBD adult heart transplants from January 2019 to June 2024 using the UNOS database. Propensity scores were generated based on clinically relevant covariates, and 1-to-1 propensity-score matching was performed. Survival analysis was conducted using Cox proportional hazards regression and Kaplan-Meier curves, with the log-rank test comparing overall survival and the Wald test examining yearly survival rates between DCD and DBD groups.
Results:
Mortality was not significantly different between DCD and DBD total cohorts (hazard ratio [HR] = 1.1, 95% confidence interval [CI] 0.9-1.3, p = 0.493). After propensity-score matching, balanced cohorts of 1,423 DCD and 1,423 DBD transplants were created with standardized mean difference among covariates well below 6%. In the matched cohort, DCD transplant mortality was 1.2 times higher than that of DBD transplants (HR 1.2, 95% CI 0.9-1.5). Kaplan-Meier curves revealed nonsignificantly lower overall survival for DCD recipients (log-rank p = 0.096). Survival rates were comparable in year 1: 91.6% vs 91.5%, p = 0.96, but significant differences emerged in subsequent years: 84.7% vs 89.4%, p = 0.007 in year 2; 80.3% vs 85.6%, p = 0.025 in year 3.
Conclusions:
Intermediate-term survival following DCD heart transplantation may be lower compared to DBD transplantation. Further investigation is warranted to identify the underlying factors contributing to this potential disparity.
