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Updated: Jan 17, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Cardiac Allograft Vasculopathy After Donation After Circulatory Death Heart Transplantation
Syed Shahyan Bakhtiyar1, Sara Sakowitz2, Saad Mallick2
1Cardiovascular Outcomes Research Laboratories (CORELAB), Department of Surgery, University of California, Los Angeles, Los Angeles, California; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Insights
Donation after circulatory death (DCD) heart transplantation (HT) shows comparable survival to standard recovery (DBD/SR). However, thoracoabdominal normothermic regional perfusion (DCD/TA-NRP) procurement is linked to higher cardiac allograft vasculopathy (CAV) risk, unlike direct procurement with normothermic machine perfusion (DCD/DP-NMP).
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Donation after circulatory death (DCD) heart transplantation (HT) use is increasing, with survival rates similar to donation after brain death/standard recovery (DBD/SR).
- Cardiac allograft vasculopathy (CAV) is a primary cause of morbidity after HT.
- Analysis of CAV incidence in DCD recipients is crucial for understanding long-term outcomes.
Purpose of the Study:
- To compare the incidence of cardiac allograft vasculopathy (CAV) in recipients of DCD heart allografts versus DBD/SR allografts.
- To evaluate differences in CAV incidence between two DCD procurement methods: direct procurement with normothermic machine perfusion (DCD/DP-NMP) and thoracoabdominal normothermic regional perfusion (DCD/TA-NRP).
Main Methods:
- Utilized the Organ Procurement and Transplantation Network database for adult HT recipients from December 2019 to January 2024.
- Stratified DCD recipients into DCD/DP-NMP and DCD/TA-NRP groups.
- Assessed the primary outcome of CAV incidence within the first posttransplant year, adjusting for comprehensive risk factors.
Main Results:
- Out of 12,060 transplants, 93.4% used DBD/SR, 4.7% used DCD/DP-NMP, and 1.9% used DCD/TA-NRP allografts.
- One-year CAV incidence was 4.0% (DBD/SR), 3.8% (DCD/DP-NMP), and 7.1% (DCD/TA-NRP).
- DCD/TA-NRP was associated with a significantly higher hazard of CAV (HR 1.83) compared to DBD/SR, while DCD/DP-NMP showed comparable CAV hazard (HR 1.51).
Conclusions:
- DCD/TA-NRP procurement is associated with an increased risk of cardiac allograft vasculopathy (CAV) in heart transplant recipients.
- DCD/DP-NMP procurement method did not show a significantly increased risk of CAV compared to standard DBD/SR.
- These findings highlight the importance of procurement method in DCD heart transplantation outcomes regarding CAV development.
Background:
Use of donation after circulatory death (DCD) heart transplantation (HT) has dramatically expanded, with survival comparable to donation after brain death/standard recovery (DBD/SR). As cardiac allograft vasculopathy (CAV) remains a leading cause of post-HT morbidity, we sought to analyze CAV incidence among DCD recipients.
Methods:
We used the Organ Procurement and Transplantation Network to tabulate adult (≥18 years) HT recipients between December 2019 and January 2024. DCD recipients were further stratified into the direct procurement with normothermic machine perfusion (DCD/DP-NMP) and thoracoabdominal normothermic regional perfusion (DCD/TA-NRP). The primary outcome of interest was the incidence of CAV over the first posttransplant year.
Results:
Of 12,060 transplants, 11,262 (93.4%) used DBD/SR allografts, 566 (4.7%) used DCD/DP-NMP allografts, and 232 (1.9%) used DCD/TA-NRP allografts. The overall incidence of CAV at 1 year was 4.0% for the DBD/SR group, 3.8% for DCD/DP-NMP, and 7.1% for DCD/TA-NRP. After comprehensive risk adjustment, transplantation with DCD/TA-NRP allografts remained associated with greater hazard of CAV over the first posttransplant year, relative to DBD/SR (hazard ratio [HR] 1.83; 95% CI, 1.08-3.10). However, DCD/DP-NMP procurement was linked with comparable CAV hazard as DBD/SR (HR, 1.51; 95% CI, 0.92-2.50). Considering recipients at high-volume centers, DCD/TA-NRP remained significantly associated with increased hazard of CAV (HR, 2.22; 95% CI, 1.27-3.89; reference: DBD/SR).
Conclusions:
In this national analysis of CAV incidence among DCD HT recipients, DCD/TA-NRP, but not DCD/DP-NMP, was associated with greater risk of CAV.
