Long-Term Outcomes From a Decade of Donation After Circulatory Death Heart Transplantation in Australia

Heart transplantation (HT) from donation after circulatory death (DCD) donors has successfully expanded the donor pool with excellent short-term survival outcomes, but there is uncertainty regarding long-term outcomes.

This study compared 10-year patient survival and freedom from cardiac allograft vasculopathy (CAV) in recipients of DCD hearts with a contemporary cohort of recipients of hearts from donation after brain death (DBD) donors.

The study included consecutive heart transplant recipients at St Vincent's Hospital Sydney (Darlinghurst, New South Wales, Australia) from the commencement of the DCD heart transplant program in July 2014 until December 2024. Outcomes for recipients of DCD hearts (n = 118) vs DBD hearts (n = 385) were compared. DCD hearts were retrieved using a direct procurement protocol with normothermic machine perfusion. DBD hearts were retrieved with either static cold storage (n = 336) or hypothermic machine perfusion (n = 49).

There were no significant differences in short- or long-term survival between DCD and DBD heart transplant recipients (1-year survival: 94% vs 88%; 10-year survival: 67% vs 64%, respectively; HR: 0.9 [95% CI: 0.5-1.4]; P = 0.5). The 10-year freedom from CAV was 61% and 41% for the DCD and DBD recipient groups, respectively (P = 0.5). There was no significant difference in the incidence of severe primary graft dysfunction when comparing DCD recipients with DBD recipients (14% vs 14%, respectively). Asystolic warm ischemic time was found to be the only retrieval-specific independent risk factor for severe primary graft dysfunction in DCD HT (OR: 1.4 [95% CI: 1.1-2.0]; P = 0.03).

Heart transplant recipients from DCD donors have similar survival and freedom from CAV at 10 years post HT when compared with a contemporary cohort of recipients from DBD donors. These findings establish the long-term safety and efficacy of DCD HT.