Cardiac allograft vasculopathy and secondary outcomes at 1-year in heart transplantation from circulatory death...

Area of Science:

• Cardiovascular Surgery
• Transplantation Immunology
• Organ Procurement

Background:

• Cardiac allograft vasculopathy (CAV) is a primary cause of graft failure and mortality post-heart transplantation (HT), particularly after the first year.
• The increasing use of donation after circulatory death (DCD) donors necessitates understanding their impact on CAV risk compared to donation after brain death (DBD) donors.
• Variations in DCD procurement techniques, such as direct procurement and perfusion (DPP) versus normothermic regional perfusion (NRP), may influence CAV development.

Purpose of the Study:

• To compare the one-year risk of cardiac allograft vasculopathy (CAV) between heart transplant recipients from donation after brain death (DBD) and donation after circulatory death (DCD) donors.
• To investigate whether the procurement technique used for DCD donors (DPP vs. NRP) affects the one-year CAV risk compared to DBD donors.
• To evaluate secondary clinical outcomes, including graft survival and patient health status, at one year post-transplant.

Main Methods:

• Analysis of adult heart transplants from the UNOS registry between January 2020 and June 2024, with follow-up through June 2025.
• Comparison of one-year CAV rates between DBD and DCD recipients using unadjusted and adjusted logistic regression.
• Creation of propensity-score matched DBD and DCD cohorts within the same transplant centers to control for center-specific practices; separate matched cohorts compared DPP and NRP techniques against DBD controls.

Main Results:

• One-year CAV rates were similar between DBD (6.22%) and DCD (5.90%) recipients (adjusted OR 0.99; p=0.94) among 12,630 eligible transplants.
• This finding was consistent across multiple adjusted models and in propensity-matched pairs (6.51% vs. 5.61%; OR 0.85; p=0.37).
• No significant differences in one-year CAV risk were observed when stratifying DCD recipients by procurement method (DPP vs. NRP).

Conclusions:

• One-year cardiac allograft vasculopathy (CAV) and key secondary clinical outcomes are comparable between donation after brain death (DBD) and donation after circulatory death (DCD) heart transplant recipients.
• The procurement method for DCD donors (DPP or NRP) does not appear to influence one-year CAV risk relative to DBD donors.
• Further research is required to clarify the intermediate and long-term CAV risk associated with DCD heart transplantation.