Transplantation Outcomes with Donor Hearts after Circulatory Death

This multicenter, randomized, noninferiority trial compared outcomes after heart transplantation using donor hearts retrieved following circulatory death (DCD) and reanimated via extracorporeal nonischemic perfusion, versus traditional cold-stored hearts from brain-dead donors. Among 180 transplant recipients (90 in each group), 6-month survival was 94% with DCD hearts and 90% with brain-death donor hearts (risk-adjusted mean difference: –3 percentage points; 90% CI, –10 to 3; P<0.001 for noninferiority). Serious graft-related adverse events at 30 days were comparable, although moderate or severe primary graft dysfunction occurred more frequently in the DCD group (22% vs. 10%). Donor heart utilization from DCD donors reached 89%. Despite higher graft dysfunction rates, no retransplantations occurred in the DCD group, and long-term survival with the original graft was high. These findings support broader adoption of DCD heart transplantation using perfusion-based viability assessment.

This multicenter, randomized, noninferiority trial compared outcomes after heart transplantation using donor hearts retrieved following circulatory death (DCD) and reanimated via extracorporeal nonischemic perfusion, versus traditional cold-stored hearts from brain-dead donors. Among 180 transplant recipients (90 in each group), 6-month survival was 94% with DCD hearts and 90% with brain-death donor hearts (risk-adjusted mean difference: –3 percentage points; 90% CI, –10 to 3; P<0.001 for noninferiority). Serious graft-related adverse events at 30 days were comparable, although moderate or severe primary graft dysfunction occurred more frequently in the DCD group (22% vs. 10%). Donor heart utilization from DCD donors reached 89%. Despite higher graft dysfunction rates, no retransplantations occurred in the DCD group, and long-term survival with the original graft was high. These findings support broader adoption of DCD heart transplantation using perfusion-based viability assessment.