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. 2024 Oct 15;3(1):229-234.
doi: 10.1016/j.atssr.2024.09.016. eCollection 2025 Mar.

Outcomes of Donation After Circulatory Death Heart Transplantation Using Normothermic Regional Perfusion

Akshay Kumar  1 , Amit Alam  2 , Michael Dorsey  1 , Les James  1 , Syed Hussain  1 , Bernard Kadosh  2 , Randal Goldberg  2 , Alex Reyentovich  2 , Nader Moazami  1 , Deane Smith  1
Affiliations

Outcomes of Donation After Circulatory Death Heart Transplantation Using Normothermic Regional Perfusion

Akshay Kumar et al. Ann Thorac Surg Short Rep. .

Abstract

Background: Donation after circulatory death (DCD) with cardiopulmonary bypass for thoracoabdominal normothermic regional perfusion (TA-NRP) has led to increased use of donor hearts. Rejection rates and long-term survival outcomes are not known.

Methods: A single-center retrospective cohort review of patients who underwent DCD heart transplantation from January 2020 to December 2023 was performed. Donor and recipient characteristics, operative characteristics, and posttransplantation outcomes were analyzed. Subgroup analysis comparing co-localized vs distant donors and recipients was performed. The primary end point was 1-year survival. Secondary end points included incidences of primary graft dysfunction (PGD), cardiac allograft vasculopathy (CAV), rejection rate, and overall mortality. Our TA-NRP protocol has remained the same, consisting of sternotomy, ligation of aortic arch vessels, establishment of cardiopulmonary bypass, reintubation, resuscitation of the heart, and cold static storage during transport.

Results: In total, 32 recipients underwent DCD heart transplantation, including 26 isolated hearts, 3 heart-lungs, and 3 heart-kidneys. The median age was 56 years for recipients and 39 years for donors; 21 donors and recipients were co-localized, whereas 11 were distant. One-year survival was 100%. Two patients required mechanical circulatory support for PGD. Four patients experienced grade 2R acute cellular rejection. Five patients had grade 1 CAV at 1 year. On subgroup analysis, distant donors and recipients had longer warm (47 vs 30 minutes; P < .005) and cold (213 vs 76 minutes; P < .005) ischemia times, without any other differences.

Conclusions: Outcomes after DCD heart transplantation using TA-NRP remain encouraging with acceptable rates of rejection, PGD, CAV, and survival at 1 year.

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Figures

None
Graphical abstract
Figure
Figure
Sequence of events for donation after circulatory death (DCD) normothermic regional perfusion. CPB, cardiopulmonary bypass; ICU, intensive care unit; OR, operating room.
See this image and copyright information in PMC

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