Related Experiment Video
Updated: Mar 31, 2026
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Novel model to predict survival in DCD heart transplants: Development of a mortality risk score using UNOS data
Anh Nguyen1, Abbas Rana2, Alexis Shafii1
1Division of Cardiothoracic Transplantation and Circulatory Support, Department of Surgery, Baylor College of Medicine, Houston, TX.
Insights
This study developed a mortality risk score for donation after circulatory death (DCD) heart transplants, identifying key recipient and donor factors influencing survival. The score aims to improve outcomes for DCD heart recipients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Medical Statistics
Background:
- Prior research compared donation after brain death (DBD) and donation after circulatory death (DCD) heart transplant outcomes.
- This study specifically focuses on donor and recipient characteristics impacting survival in DCD heart transplants.
- A novel risk score was developed exclusively for DCD heart transplantation.
Purpose of the Study:
- To identify donor and recipient characteristics influencing survival in donation after circulatory death (DCD) heart transplants.
- To develop a predictive mortality risk score tailored for DCD heart recipients.
- To enhance risk stratification and potentially improve outcomes in DCD heart transplantation.
Main Methods:
- Analysis of adult DCD heart transplants from the UNOS database (January 2019 - June 2024).
- Multivariable Cox proportional hazards regression used to assess mortality risk factors.
- Development of a mortality risk score based on significant risk factors and clinically relevant variables.
Main Results:
- One-, two-, and three-year survival rates for DCD heart transplants were 91.6%, 84.8%, and 80.3%, respectively.
- Significant mortality risk factors included recipient age >65, female sex, diabetes, prior cardiac surgery, donor male sex, longer ischemic time, and CMV mismatch.
- Several other factors, though not statistically significant, were included in the risk score due to large effect sizes and clinical relevance.
Conclusions:
- A comprehensive mortality risk score for DCD heart transplants was developed.
- The score incorporates recipient factors (age, sex, diabetes, prior surgery, ventilator use, IV inotropes) and donor factors (age, sex, diabetes, ischemic time, cause of death, lung retrieval, CMV status).
- This risk score can aid in better patient selection and management for DCD heart transplantation.
Background:
While prior studies have compared outcomes between donation after brain death (DBD) and donation after circulatory death (DCD) heart transplants, this study focuses on donor and recipient characteristics influencing survival and develop a risk score exclusively in DCD heart transplants.
Methods:
We analyzed adult DCD heart transplants in the UNOS database from January 2019 to June 2024. Mortality risk factors were assessed using multivariable Cox proportional hazards regression. The coefficients of the most significant factors were used to develop a mortality risk score.
Results:
Among 18,014 adult heart transplants, 1453 (8.1%) were DCD recipients. One-, two-, and three-year survival rates were 91.6%, 84.8%, and 80.3%, respectively. Statistically significant factors associated with increased mortality included recipient age >65 (HR=1.62, p=0.025), recipient female sex (HR=1.87, p=0.007), recipient diabetes (HR=1.64, p=0.009), prior cardiac surgery (HR=1.46, p=0.049), donor male sex (HR=1.96, p=0.034), longer ischemic time (HR=1.11 per hour, p=0.014) and CMV mismatch: donor-/recipient+ (HR=2.07, p=0.015); donor+/recipient- (HR=1.84, p=0.041). Though not statistically significant (p>0.05), donor age≥45, donor diabetes, donor cause of death, lung retrieval, recipients' pretransplant dialysis, IV inotropes and mechanical ventilation were also added to the mortality risk score model due to its large effect sizes and clinical relevance.
Conclusions:
We developed a mortality risk score for DCD heart transplants including 7 recipient factors: age >65, female sex, diabetes, prior cardiac surgery, pretransplant ventilator use, IV inotropes; 7 donor factors: age≥45, male sex, diabetes, ischemic time>4 h, cause of death, lung retrieval and CMV positive in either donors or recipients.
