Durable left ventricular assist device in donation after circulatory death heart transplantation

Abstract

Background: This study evaluates outcomes following donation after circulatory death (DCD) heart transplantation in recipients with a durable left ventricular assist device (LVAD).

Methods: The UNOS registry was queried to analyze adult recipients of isolated DCD heart transplantation between 1/1/2019-3/31/2023. The recipients were stratified by durable LVAD use as a bridge to transplantation. The primary outcome was 1-year post-transplant survival. Sub-group analyses were conducted to evaluate the effects of transplant status, device type, and donor type on 1-year survival.

Results: A total of 703 recipients were included, of which 219 (31.2%) recipients were bridged with a durable LVAD. The recipients of DCD hearts with durable LVADs had significantly lower 1-year post-transplant survival compared to those without durable LVADs (88.4% vs. 93.6%, p=0.017). Among the recipients bridged with durable LVADs, status 4 recipients had significantly improved 1-year survival compared to statuses 2 and 3 recipients, similar to those without durable LVADs. Furthermore, the recipients with HeartMate II and HeartMate 3 had improved survival compared to those with the HeartWare HVAD, similar to those without durable LVADs. Lastly, the DCD and DBD recipients with durable LVADs had comparable 1-year survival (88.4% vs. 89.0%, p=0.763).

Conclusions: Recipients of DCD hearts bridged to transplantation with a durable LVAD exhibit reduced early post-transplant survival compared to those without a durable LVAD. However, clinical acuity and device type significantly influence post-transplant outcomes in this vulnerable population. Despite this, candidates with a durable LVAD can safely undergo DCD heart transplantation, achieving early post-transplant survival comparable to those of DBD heart transplantation.

Keywords: donation after circulatory death; durable left ventricular assist device; mechanical circulatory support; orthotopic heart transplantation; post-transplant outcomes.