DCDD heart transplantation with thoraco-abdominal normothermic regional perfusion and static cold storage: The experience in Spain

Abstract

Heart transplantation from donors after the circulatory determination of death is expanding worldwide. Thoraco-abdominal normothermic regional perfusion (TA-NRP) allows the validation and recovery of the donation after the circulatory determination of death (DCDD) heart, but there is limited evidence on the results of heart transplants performed with this approach. This multicenter, nationwide, prospective study describes the short-term outcomes of adult patients receiving a DCDD heart transplant obtained via TA-NRP followed by static cold storage in Spain. Recipients of hearts from donors after the neurologic determination of death were used as controls. The primary outcome was a composite of 1-year all-cause death or severe primary graft failure. During 2020-2023, 98 adult DCDD and 347 donations after the neurologic determination of death (DNDD) heart transplants were performed across 11 centers. The primary outcome was met by 21 (21.4%) and 77 (22.2%) patients, respectively (P = .87). Thirty-day and 1-year survival were 94.9% and 88.8% in the DCDD vs 93.7% and 87.3% in the DNDD group (P = .70), respectively. Severe primary graft failure was observed in 13 (13.3%) vs 52 (15.0%) patients (P = .67). By inverse probability weighting, the DCDD heart was not associated with the primary outcome (hazard ratio, 0.97; 95% confidence interval, 0.58-1.62; P = .91). In conclusion, adult DCDD heart transplantation based on TA-NRP and static cold storage provides similar short-term outcomes than DNDD heart transplants.

Keywords: donation after the circulatory determination of death; heart transplantation; normothermic regional perfusion.