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. 2025 Jun 26:9:100330.
doi: 10.1016/j.jhlto.2025.100330. eCollection 2025 Aug.

Days alive and out of the hospital at 1 year following heart transplant: Comparing donation after brain death versus after circulatory death

Fadi M Azar  1 , Antoinette S Birs  2 , Quan M Bui  2 , Nicholas Wettersten  2 , Hao A Tran  2 , Mark J Kearns  3 , Victor Pretorius  3 , Marcus A Urey  2
Affiliations

Days alive and out of the hospital at 1 year following heart transplant: Comparing donation after brain death versus after circulatory death

Fadi M Azar et al. JHLT Open. .

Abstract

Background: Heart transplantation (HTx) remains the definitive therapy for select patients with Stage D heart failure. Donation after circulatory death (DCD) has emerged as a promising strategy to expand the donor pool, with studies showing comparable survival to donation after brain death (DBD). However, little is known about how DCD impacts post-transplant quality of life. Days alive and out of the hospital (DAOH) at 1 year is a validated, patient-centered metric reflecting both post-transplant morbidity and survival.

Methods: We conducted a single-center, retrospective cohort study of 226 adult patients who underwent HTx between January 2021 and June 2023 (117 DBD and 109 DCD recipients). The primary outcome was DAOH at 1 year. Secondary outcomes included post-transplant graft function, inotrope and intensive care unit (ICU) duration, readmissions, and mortality. Baseline characteristics and outcomes were compared using appropriate statistical methods, and quantile regression was used to adjust for clinical confounders.

Results: Baseline characteristics were largely similar, although DBD recipients had higher pre-operative acuity. Median DAOH at 1 year did not differ significantly between DBD and DCD recipients (344 vs 343 days; p = 0.896). Adjusted analyses confirmed no clinically meaningful difference. Secondary outcomes, including 1-year mortality, ICU stay, and readmission rates, were also comparable.

Conclusions: In this cohort, DCD recipients achieved similar DAOH at 1 year compared to DBD recipients, supporting the use of DCD as a viable strategy in HTx. This is one of the first studies to compare post-transplant quality of life in DBD and DCD HTx recipients.

Keywords: Days alive and out of the hospital; Donation after brain death; Donation after circulatory death; Heart transplant; Quality of life.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Flowchart representation of study population and subsequent outcomes of consecutive heart offers made to adult patients at UC San Diego between January 1, 2023, and June 30, 2023.
Figure 2
Figure 2
distribution of days alive and out of the hospital at 1 year.
See this image and copyright information in PMC

References

    1. Truby L.K., Rogers J.G. Advanced heart failure: epidemiology, diagnosis, and therapeutic approaches. JACC Heart Fail. 2020;8:523–536. doi: 10.1016/j.jchf.2020.01.014. - DOI - PubMed
    1. Virani S.S., Alonso A., Benjamin E.J., et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141:e139–e596. doi: 10.1161/CIR.0000000000000757. - DOI - PubMed
    1. Savarese G., Becher P.M., Lund L.H., Seferovic P., Rosano G.M.C., Coats A.J.S. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118:3272–3287. doi: 10.1093/cvr/cvac013. - DOI - PubMed
    1. Wilhelm M.J. Long-term outcome following heart transplantation: current perspective. J Thorac Dis. 2015;7:549–551. doi: 10.3978/j.issn.2072-1439.2015.01.46. - DOI - PMC - PubMed
    1. Mullan C.W., Sen S., Ahmad T. Left ventricular assist devices versus heart transplantation for end stage heart failure is a misleading equivalency. JACC Heart Fail. 2021;9:290–292. doi: 10.1016/j.jchf.2021.02.004. - DOI - PubMed

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