Y. Hong1,2, U. Nasim1, N. Iyanna1, A. Dorken-Gallastegi2, J. Bonatti1, P.D. Yoon1, D.R. Serna-Gallegos1, I. Sultan1, D.J. Kaczorowski1 1University Of Pittsburg, Cardiothoracic Surgery, Pittsburgh, PA, USA 2University Of Pittsburg, Surgery, Pittsburgh, PA, USA
Introduction: Donation after circulatory death (DCD) heart transplantation is a promising avenue to expand the number of donor hearts available for transplantation. Emerging evidence suggests that the use of DCD hearts is of particular benefit to candidates with lower transplant statuses, including those bridged to transplant (BTT) with a durable left ventricular assist device (LVAD). However, there is a scarcity of literature on the utilization of DCD hearts for transplantation in recipients with durable LVADs. This study aims to evaluate the outcomes of DCD heart transplantation in recipients with durable LVADs
Methods: The UNOS registry was queried to analyze adult recipients who underwent primary isolated DCD heart transplantation between 1/1/2019 and 3/31/2023, with a 1-year follow-up extending to 3/31/2024. Multi-visceral, heterotopic, redo, and DBD heart transplant recipients were excluded. The recipients were stratified into two cohorts based on the use of a durable LVAD as a BTT. The device types included HeartMate II, HeartMate 3, and HeartWare HVAD. The primary outcome was 1-year post-transplant survival. Sub-group analyses were conducted to evaluate the effects of transplant status and donor type on 1-year post-transplant survival.
Results: A total of 703 DCD heart transplant recipients were included in the study. Of these, 219 recipients (31.2%) were BTT 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; Figure A). Among the recipients BTT with durable LVADs, status 4 recipients had significantly improved 1-year post-transplant survival compared to statuses 2 and 3 recipients (91.1% vs. 87.2% vs. 79.8%, respectively, p=0.039; Figure B), similar to those without durable LVADs. Lastly, the DCD recipients with durable LVADs had comparable 1-year post-transplant survival to the DBD recipients with durable LVADs (88.4% vs. 89.0%, p=0.763; Figure C).
Conclusions: Recipients of DCD hearts bridged transplantation with a durable LVAD exhibit reduced early post-transplant survival compared to those without a durable LVAD. However, clinical acuity significantly influences post-transplant outcomes in this vulnerable population, with higher transplant status correlating with worse survival. Despite this, candidates with a durable LVAD can safely undergo DCD heart transplantation, achieving early post-transplant survival rates comparable to those of DBD heart transplantation.