Beating heart transplantation: A single center's initial experience and propensity-matched analysis against national...

Beating heart transplantation (BHT) was adopted to avoid an additional episode of cardioplegic arrest and reperfusion and reduce allograft ischemia-reperfusion injury. We sought to establish a direct comparison of outcomes between the first cohort of BHT recipients at our center and standard DCD recipients across the US.

The UNOS registry was queried to identify adult recipients who underwent first-time isolated DCD HT between 12/2019-12/2023 (before the first BHT was performed outside of our center). All adult patients who underwent first-time isolated DCD BHT between 10/2022-9/2024 at our center were included. Nearest neighbor propensity-score matching was performed and groups were compared for 30-day survival, need for post-transplant mechanical circulatory support, major complications, length of stay, and 1-year survival.

A total of 1083 standard DCD recipients and 31 BHT recipients were identified. Before matching, more BHT recipients required pre-transplant IABP (29% vs 9.8%, p=0.003) and ECMO (6.5% vs 0.7%, p=0.029), had higher status on the waitlist (Status 1-3; 97.5% vs. 62%, p<0.001), and spent fewer days waiting [7(5,14) vs 30(9149) days, p<0.001). After matching, BHT recipients demonstrated similar 30-day survival (100% vs 98.3%, p>0.9) and improved 1-year graft survival (100% vs 83.9%, p<0.001) compared to standard DCD recipients.

Despite BHT recipients being sicker than standard DCD recipients pre-transplant, their matched survival at 30-days was similar and graft survival was improved at 1-year post-transplant. While BHT may confer excellent early post-transplant outcomes, a larger sample size and longer-term follow-up are needed to confirm the survival benefit associated with BHT.