心臓移植における循環死後提供者（DCD）ドナー：施設体量は重要か？

Donation after circulatory death (DCD) donor for heart transplantation is a new practice. We sought to determine if center volume (high vs low) influenced perioperative outcomes and short-term survival.

The United Network for Organ Sharing registry was used to identify DCD heart recipients from 2019 to 2025. Recipients were stratified based on center volume: high-volume (>15 transplants over observational period from 2019-2020) or low volume (≤15 transplants). Comparative statistics and Kaplan-Meier methods with log-rank test were used to compare groups and determine survival. A Cox regression using select donor and recipient criteria was created to determine the association of center volume and mortality.

Low-volume group recipients had significantly longer waitlist times, temporary mechanical circulatory support use, and more often to be Status 1 or 2 compared to the high-volume group. However, high-volume centers had significantly higher exceptions granted per-center when compared to low-volume centers. There were no significant differences in peri-operative outcomes nor short-term survival. Following adjustment, center volume was not independently associated with increased mortality, while increasing ischemic time was.

Transplant center volume had no significant effect on peri-operative outcomes or survival after DCD heart transplantation. The discrepancy in presumed medical urgency and increased waitlist time in low-volume cohort is highlighted by significantly more exceptions granted in high-volume recipients. This should be a noted area for improvement in the new allocation system to make heart transplantation more equitable for all recipients.