Related Experiment Video

Updated: Jun 4, 2026

A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
07:08

A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death

Published on: June 6, 2025

Outcomes of DCD vs DBD Heart Transplantation: Impact of Primary Graft Dysfunction Recovery Trajectory

Naoki Tadokoro1, Taylor Nordan2, Sho Takemoto3

  • 1Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.

Journal of Cardiac Failure
|June 2, 2026
PubMed

Insights

Donation after circulatory death (DCD) heart transplants show survival comparable to donation after brain death (DBD) recipients. Primary graft dysfunction (PGD) recovery, not donor type, impacts transplant outcomes.

Area of Science:

  • Cardiology
  • Transplantation Surgery
  • Immunology

Background:

  • Donation after circulatory death (DCD) heart transplantation has higher primary graft dysfunction (PGD) rates than donation after brain death (DBD).
  • Despite higher PGD incidence, DCD and DBD heart transplant survival appear comparable.
  • The specific mortality risk conferred by PGD in DCD donors requires further investigation.

Purpose of the Study:

  • To compare 6-month survival rates between DCD and DBD heart transplant recipients.
  • To investigate the impact of primary graft dysfunction (PGD) severity and recovery trajectory on outcomes in DCD versus DBD heart transplantation.
  • To determine if PGD confers a differential mortality risk based on donor type.

Main Methods:

  • Propensity score-matched analysis of adult heart transplant recipients from the OPTN registry (September 2023-July 2025).
  • Classification of severe PGD based on recovery trajectory: Non-PGD, Transient PGD, and Persistent PGD.
  • Multivariate Cox regression, adjusted for covariates and ischemic time, to compare 6-month survival and assess PGD trajectory effects by donor type.

Main Results:

  • Six-month survival was comparable between DCD (94.3%) and DBD (93.9%) recipients (HR 0.73; p=0.09).
  • Severe PGD incidence was higher in DCD recipients (11%) compared to DBD recipients (5.4%) (p < 0.001).
  • Persistent PGD was associated with increased mortality in both DCD (HR 7.29) and DBD (HR 9.04) groups, with no statistically significant interaction (p=0.375).

Conclusions:

  • DCD and DBD heart transplant recipients achieve comparable 6-month survival.
  • The recovery trajectory of primary graft dysfunction (PGD), rather than donor type, is significantly associated with transplant outcomes.
  • These findings suggest focusing on PGD management and recovery is crucial for optimizing heart transplant success.
Abstract

Keywords:
Heart transplantationdonation after circulatory deathgraft recoveryprimary graft dysfunctionpropensity score matching

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