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Published on: May 10, 2022
Exercise Performance in Transplant Recipients of Hearts From Donation After Circulatory Death and Donation After
Lorenzo D'Angelo1, Christiana Gjelaj1, Enklajd Marsela1
1Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
Heart transplantation outcomes after donation after circulatory death (DCD) show similar exercise capacity compared to donation after brain death (DBD) recipients. Further research is needed to improve post-transplant exercise performance.
Area of Science:
- Cardiology
- Transplant Surgery
- Exercise Physiology
Background:
- Donation after circulatory death (DCD) heart transplantation (HT) is increasing.
- The impact of DCD procurement on post-transplant exercise capacity is not well understood.
- This study compares exercise performance in DCD and donation after brain death (DBD) heart transplant recipients.
Purpose of the Study:
- To compare exercise performance parameters between DCD-HT and DBD-HT recipients.
- To investigate the effects of functional ischemic injury during procurement on exercise capacity.
Main Methods:
- Retrospective, case-control study of adult isolated HT recipients (January 2022 - April 2024).
- Cardiopulmonary exercise testing (CPET) was performed post-transplant.
- DCD-HT recipients (cases) were matched to DBD-HT recipients (controls).
Main Results:
- No significant difference in peak oxygen consumption (pVO2) between DCD-HT and DBD-HT recipients.
- Longer total ischemic time was observed in the DCD group (p=0.002).
- Respiratory exchange ratio (RER) was slightly lower in the DCD group (p=0.031), with comparable ventilatory efficiency and echocardiographic indices.
Conclusions:
- DCD and DBD heart transplant recipients exhibit similar exercise performance.
- Overall exercise capacity remains limited following heart transplantation.
- Further investigation is warranted to identify mechanisms and interventions to enhance exercise capacity.
Background:
Heart transplantation (HT) following donation after circulatory death (DCD) has grown substantially in recent years. However, the effects of functional ischemic injury during procurement on exercise capacity remain unknown. We compared exercise performance parameters between DCD and donation after brain death (DBD) recipients.
Methods:
We conducted a single-center, retrospective, case-control study of adults with isolated HT between January 2022 and April 2024 and completed a treadmill cardiopulmonary exercise test (CPET) post-transplant. DCD-HT recipients (cases) were matched to DBD-HT recipients (controls) based on major demographics and CPET timing. The primary outcome was peak oxygen consumption (pVO2). Secondary outcomes included additional exercise capacity parameters and echocardiographic indices at peak exercise.
Results:
Cases (DCD-HT: n = 10, 20% female) and controls (DBD-HT: n = 10, 20% female) had similar baseline characteristics. Total ischemic time was longer in the DCD group (6.9 [interquartile range (IQR): 6.4-7.1] vs. 4.6 [IQR: 3.94.8] h; p = 0.002). Time from HT to CPET did not differ. DCD and DBD-HT recipients had similar pVO2 (17.1 [IQR: 15.2-19.7] vs. 19.7 [IQR: 13.3-21.2] mL/kg/min; p = 0.545). Respiratory exchange ratio (RER) was slightly lower in the DCD group (1.1 [IQR: 1.0-1.2] vs. 1.2 [IQR: 1.21.3]; p = 0.031). Ventilatory efficiency (VE/VCO2) at anaerobic threshold, left ventricular ejection fraction, and E/e' at peak exercise were comparable between groups.
Conclusion:
DCD and DBD heart transplant recipients demonstrate similar exercise performance. Overall, exercise capacity remains limited after HT, highlighting the need for further studies to identify underlying mechanisms and potential therapeutic interventions.
