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Published on: October 12, 2014
Cardiac Allograft Vasculopathy in Heart Transplantation From Circulatory Death Donors: A Systematic Review and
Wasif Safdar1, Marvyn Allen G Chan2, Lorenzo D'Angelo3
1Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
Heart transplant recipients using donation after circulatory death (DCD) donors show similar 1-year cardiac allograft vasculopathy (CAV) incidence and mortality compared to donation after brain death (DBD) recipients. This supports wider DCD donor utilization.
Area of Science:
- Cardiology
- Transplantation Immunology
- Public Health
Background:
- Cardiac allograft vasculopathy (CAV) is a significant long-term complication after heart transplantation (HT).
- The increasing use of donation after circulatory death (DCD) donors necessitates evaluating their impact on CAV incidence.
- Understanding CAV rates in DCD versus donation after brain death (DBD) recipients is critical for donor selection and patient outcomes.
Purpose of the Study:
- To compare the 1-year incidence of cardiac allograft vasculopathy (CAV) in heart transplant recipients who received organs from DCD donors versus DBD donors.
- To assess and compare the 1-year mortality rates between DCD and DBD heart transplant recipients.
Main Methods:
- A systematic review and meta-analysis of studies published between January 2010 and December 2024.
- Inclusion of studies comparing 1-year CAV incidence and mortality between DCD and DBD heart transplant recipients.
- Pooled analysis of odds ratios (OR) with 95% confidence intervals (CI) using fixed and random-effects models.
Main Results:
- Four studies, including 951 heart transplants (576 DBD, 375 DCD), met the inclusion criteria.
- No significant difference was found in the 1-year CAV incidence between DCD and DBD recipients (OR = 0.71, 95% CI: 0.43-1.17, p = 0.17).
- Similarly, 1-year mortality rates were comparable between the two donor groups (OR = 0.87, 95% CI: 0.48-1.58, p = 0.66).
Conclusions:
- Heart transplant recipients from DCD donors exhibit comparable 1-year CAV incidence and mortality to those from DBD donors.
- These findings advocate for the continued and expanded use of DCD donors to mitigate donor heart shortages.
- The study supports the safety and efficacy of utilizing DCD organs in heart transplantation programs.
Background:
Cardiac allograft vasculopathy (CAV) remains a major cause of long-term morbidity and mortality after heart transplantation (HT). With the growing use of donation after circulatory death (DCD) donors, it is crucial to assess the incidence of CAV in this population.
Methods:
We conducted a systematic review and meta-analysis of studies published between January 2010 and December 2024. comparing 1-year CAV incidence and 1-year mortality between DCD and donation after brain death (DBD) HT recipients. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using fixed and random-effects models.
Results:
Four studies met inclusion criteria, comprising 951 HTs (576 DBD and 375 DCD). Of these, 594 HTs contributed to the CAV analysis and 914 to the mortality analysis. Pooled analysis demonstrated no significant difference in 1-year CAV incidence between DCD and DBD recipients (OR = 0.71, 95% CI: 0.43-1.17, p = 0.17). Similarly, no difference was observed in 1-year mortality (OR = 0.87, 95% CI: 0.48-1.58, p = 0.66).
Conclusions:
DCD and DBD-HT recipients demonstrated comparable 1-year CAV incidence and mortality. These findings support the continued and expanded use of DCD donors to address the ongoing shortage of suitable donor hearts.
