Controlled DCD heart re-transplantation enabled by ex-situ normothermic perfusion: First UK case and implications for...

Area of Science:

• Cardiology
• Transplantation Medicine
• Organ Donation

Background:

• Cardiac re-transplantation is infrequent and associated with high peri-operative risks.
• Donation after circulatory death (DCD) donors, preserved with ex-situ normothermic perfusion, are increasingly used, expanding the donor pool.
• Experience with DCD donors in cardiac re-transplantation remains limited.

Purpose of the Study:

• To describe the first UK case of orthotopic heart re-transplantation using a controlled DCD donor.
• To evaluate the use of ex-situ normothermic perfusion for preserving a DCD heart for re-transplantation.
• To report outcomes following re-transplantation for primary graft failure.

Main Methods:

• Orthotopic heart re-transplantation was performed using a controlled DCD donor heart.
• The donor heart was preserved using ex-situ normothermic perfusion.
• The recipient had experienced severe irrecoverable primary graft failure 140 days post-index transplantation.

Main Results:

• Successful orthotopic heart re-transplantation was achieved using a DCD donor heart preserved with normothermic perfusion.
• This represents the first reported case in the UK utilizing this specific donor type and preservation method for cardiac re-transplantation.
• The patient presented with severe early graft dysfunction involving both ventricles, meeting criteria for primary graft failure.

Conclusions:

• Ex-situ normothermic perfusion of controlled DCD donor hearts is a viable option for cardiac re-transplantation.
• This case expands the evidence base for using DCD donors in complex cardiac re-transplantation scenarios.
• Further research is warranted to establish the long-term outcomes and safety of this approach.