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Improved Outcomes in Severe Primary Graft Dysfunction After Heart Transplantation Following Donation After Circulatory Death Compared With Donation After Brain Death

Published:November 06, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.10.429

      Highlights

      • Severe PGD is more common in heart transplant following DCD than following DBD.
      • Among patients with severe PGD, DCD recipients recover faster than DBD recipients.
      • PGD following DCD heart transplant may better be described as delayed graft function.
      • DCD is a safe and effective tool for expanding the heart-donor pool.

      ABSTRACT

      Background

      Primary graft dysfunction (PGD), the leading cause of early mortality after heart transplantation, is more common following donation after circulatory death (DCD) than donation after brain death (DBD). We conducted a single-center, retrospective cohort study to compare the incidence, severity and outcomes of patients experiencing PGD after DCD compared to DBD heart transplantation.

      Methods and Results

      Medical records were reviewed for all adult heart transplant recipients at our institution between March 2016 and December 2021. PGD was diagnosed within 24 hours after transplant according to modified International Society for Heart and Lung Transplant criteria. A total of 459 patients underwent isolated heart transplantation during the study period, 65 (14%) following DCD and 394 (86%) following DBD. The incidence of moderate or severe PGD in DCD and DBD recipients was 34% and 23%, respectively (P = 0.070). DCD recipients were more likely to experience severe biventricular PGD than DBD recipients (19% vs 7.4%; P = 0.004). Among patients with severe PGD, DCD recipients experienced shorter median (Q1, Q3) duration of post-transplant mechanical circulatory support (6 [4, 7] vs 9 [5, 14] days; P = 0.039), shorter median post-transplant hospital length of stay (17 [15, 29] vs 52 [26, 83] days; P = 0.004), and similar 60-day survival rates (100% [95% CI: 76.8%–100%] vs 80.0% [63.1%–91.6%]; P = 0.17) and overall survival (log-rank; P = 0.078) compared with DBD recipients.

      Conclusions

      DCD heart transplant recipients were more likely to experience severe, biventricular PGD than DBD recipients. Despite this, DCD recipients with severe PGD spent fewer days on mechanical circulatory support and in the hospital than similar DBD patients. These findings suggest that patterns of graft dysfunction and recovery may differ between donor types, and they support the expansion of the heart-donor pool with DCD.

      Key Words

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      References

        • Wilhelm MJ.
        Long-term outcome following heart transplantation: current perspective.
        J Thorac Dis. 2015; 7: 549-551
        • Khush KK
        • Cherikh WS
        • Chambers DC
        • Harhay MO
        • Hayes Jr, D
        • Hsich E
        • et al.
        The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth Adult Heart Transplantation Report: 2019; focus theme: donor and recipient size match.
        J Heart Lung Transplant. 2019; 38: 1056-1066
        • Benck L
        • Kransdorf EP
        • Emerson DA
        • Rushakoff J
        • Kittleson MM
        • Klapper EB
        • et al.
        Recipient and surgical factors trigger severe primary graft dysfunction after heart transplant.
        J Heart Lung Transplant. 2021; 40: 970-980
        • Foroutan F
        • Alba AC
        • Stein M
        • Krakovsky J
        • Chien KGW
        • Chih S
        • et al.
        Validation of the International Society for Heart and Lung Transplantation primary graft dysfunction instrument in heart transplantation.
        J Heart Lung Transplant. 2019; 38: 260-266
        • Nicoara A
        • Ruffin D
        • Cooter M
        • Patel CB
        • Thompson A
        • Schroder JN
        • et al.
        Primary graft dysfunction after heart transplantation: incidence, trends, and associated risk factors.
        Am J Transplant. 2018; 18: 1461-1470
        • Quader M
        • Hawkins RB
        • Mehaffey JH
        • Mazimba S
        • Ailawadi G
        • Yarboro L
        • et al.
        Primary graft dysfunction after heart transplantation: outcomes and resource utilization.
        J Card Surg. 2019; 34: 1519-1525
        • Sabatino M
        • Vitale G
        • Manfredini V
        • Masetti M
        • Borgese L
        • Maria Raffa G
        • et al.
        Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: epidemiology, risk factors, and outcomes.
        J Heart Lung Transplant. 2017; 36: 1217-1225
        • Squiers JJ
        • Saracino G
        • Chamogeorgakis T
        • MacHannaford JC
        • Rafael AE
        • Gonzalez-Stawinski GV
        • et al.
        Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume centre.
        Eur J Cardio-Thorac Surg. 2016; 51: 263-270
        • Wright M
        • Takeda K
        • Mauro C
        • Jennings D
        • Kurlansky P
        • Han J
        • et al.
        Dose-dependent association between amiodarone and severe primary graft dysfunction in orthotopic heart transplantation.
        J Heart Lung Transplant. 2017; 36: 1226-1233
        • Singh SSA
        • Dalzell JR
        • Berry C
        • Al-Attar N
        Primary graft dysfunction after heart transplantation: a thorn amongst the roses.
        Heart Fail Rev. 2019; 24: 805-820
        • Jawitz OK
        • Raman V
        • DeVore AD
        • Mentz RJ
        • Patel CB
        • Rogers J
        • et al.
        Increasing the United States heart transplant donor pool with donation after circulatory death.
        J Thorac Cardiovasc Surg. 2020; 159: e307-e309
        • Madan S
        • Saeed O
        • Forest SJ
        • Goldstein DJ
        • Jorde UP
        • Patel SR.
        Feasibility and potential impact of heart transplantation from adult donors after circulatory death.
        J Am Coll Cardiol. 2022; 79: 148-162
        • Chew H
        • Lo P
        • Cao J
        • Sugianto N
        • Dhital K
        • Granger E
        • et al.
        Retrospective single centre comparison of outcomes between standard criteria and marginal criteria brain dead heart transplantation.
        J Heart Lung Transplant. 2016; 35: S296
        • Dhital K
        • Ludhani P
        • Scheuer S
        • Connellan M
        • Macdonald P.
        DCD donations and outcomes of heart transplantation: the Australian experience.
        Indian J Thorac Cardiovasc Surg. 2020; 36: 224-232
        • Messer S
        • Cernic S
        • Page A
        • Berman M
        • Kaul P
        • Colah S
        • et al.
        A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors.
        J Heart Lung Transplant. 2020; 39: 1463-1475
        • Schroder JN
        • Shah A
        • Pretorius V
        • Smith J
        • Daneshmand M
        • Geirsson A
        • et al.
        Expanding heart transplants from donors after circulatory death (DCD): results of the first randomized controlled trial using the Organ Care System (OCS™) Heart: (OCS DCD Heart Trial).
        J Heart Lung Transplant. 2022; 41: S72
        • Truby LK
        • Kwee LC
        • Agarwal R
        • Grass E
        • DeVore AD
        • Patel CB
        • et al.
        Proteomic profiling identifies CLEC4C expression as a novel biomarker of primary graft dysfunction after heart transplantation.
        J Heart Lung Transplant. 2021; 40: 1589-1598
        • Kobashigawa J
        • Zuckermann A
        • Macdonald P
        • Leprince P
        • Esmailian F
        • Luu M
        • et al.
        Report from a consensus conference on primary graft dysfunction after cardiac transplantation.
        J Heart Lung Transplant. 2014; 33: 327-340
        • Al-Adhami A
        • Avtaar Singh SS
        • De SD
        • Singh R
        • Panjrath G
        • Shah A
        • et al.
        Primary graft dysfunction after heart transplantation: unravelling the enigma.
        Curr Probl Cardiol. 2021; 47100941
        • Ayer A
        • Schroder JN
        • Casalinova S
        • Doberne JW
        • Bryner BS
        • Patel CB
        • et al.
        The future of heart procurement with donation after circulatory death: current practice and opportunities for advancement.
        J Heart Lung Transplant. 2022; 41: 1385-1390
        • Quader M
        • Toldo S
        • Chen Q
        • Hundley G
        • Kasirajan V.
        Heart transplantation from donation after circulatory death donors: Present and future.
        J Card Surg. 2020; 35: 875-885
        • Ardehali A
        • Esmailian F
        • Deng M
        • Soltesz E
        • Hsich E
        • Naka Y
        • et al.
        Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED II): a prospective, open-label, multicentre, randomised non-inferiority trial.
        Lancet. 2015; 385: 2577-2584
        • Hoffman JRH
        • McMaster WG
        • Rali AS
        • Rahaman Z
        • Balsara K
        • Absi T
        • et al.
        Early US experience with cardiac donation after circulatory death (DCD) using normothermic regional perfusion.
        J Heart Lung Transplant. 2021; 40: 1408-1418
        • Smith DE
        • Kon ZN
        • Carillo JA
        • Chen S
        • Gidea CG
        • Piper GL
        • et al.
        Early experience with donation after circulatory death heart transplantation using normothermic regional perfusion in the United States.
        J Thorac Cardiovasc Surg. 2021; 164: 557-568