Spanish Center's Early Experience With Donation Following Circulatory Death in Heart Transplantation

Abstract

Heart transplantation using donation after circulatory death (DCD) has recently re-emerged alongside donation after brain death (DBD). This technique can potentially increase the number of available cardiac grafts. However, its clinical outcomes remain limited. We compared data from patients who received grafts from DCD versus DBD between 2012 and 2023. During this period, 131 adult patients underwent isolated heart transplantation. Of these, 25 (19%) were DCD donors. Donation after circulatory death donors were predominantly local (66% vs . 42%; p = 0.027). Donation after circulatory death graft recipients had fewer ventricular assist devices (12% vs . 35%; p = 0.025) and were less frequently urgent (12% vs . 39%; p = 0.009). Donation after circulatory death grafts had shorter myocardial ischemia and extracorporeal circulation times than DBD grafts (70 min [63.5-91] vs . 168 [83-219]; p < 0.001); (90 min [78-103) vs . 120 [96-148], p < 0.001). We observed no significant differences in the incidence of primary graft failure (16% vs . 22%; p = 0.526) or hospital mortality (8% vs . 14%; p = 0.410) between both groups. In conclusion, cardiac DCD demonstrates hospital outcomes comparable to those of cardiac DBD. Further long-term follow-up of these patients is necessary to determine their rejection, graft vascular disease, and mortality outcomes.