(248) Early Graft Function by Hemodynamics is Similar Between Brain Death (DBD) and Circulatory Death Donors (DCD)

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S120 - S121
• Main Authors: Duran, A., Rubarth, R., Agdashian, D., Kumar, A., Bui, Q., McLenon, M., Rodriguez, J. Cruz, Urey, M., Adler, E., Wettersten, N., Tran, H., Kearns, M., Pretorius, V., Enciso, J. Silva
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.1552

Heart transplants (HT) from donors after circulatory death (DCD) have been slowly adopted in the United States. Differences in procurement of DCD organs could increase risk of graft dysfunction due to prolonged ischemia after withdrawal of life-support and agonal time. Two methods exist for DCD heart procurement: an ex vivo perfusion system (TransMedics Organ Care System [OCS]) and normothermic regional perfusion (NRP) with extracorporeal membrane oxygenation. The differences of each procurement method could be responsible for abnormal hemodynamic indices. We sought to compare hemodynamic parameters in HT from donor after brain death (DBD) vs DCS and OCS vs NRP donors.
Single-center, retrospective study of all HT performed at our institution beginning the year of our first DCD HT. We divided our cohort by DBD and DCD transplants. In addition, we compared the two methods of DCD procurement, OCS and NRP. Measurements from protocolized, routine right heart catheterizations (RHC) at 10 to 14 days post-transplant were used for this analysis.
A total of 226 HT from 01/2020 to 9/2022 were included, 154 (68.1%) DBD and 72 (31.9%) DCD HT. Within the DCD cohort, 16 (22%) were procured by OCS and 56 (78%) by NRP. The RHC was performed at a mean of 10.8 days (SD 2.3). When comparing DBD to DCD, the only significant difference was mean pulmonary artery pressure. (Table 1) No statistically significant differences in hemodynamics were observed between the two methods of DCD procurement (Table 2).
Hemodynamic indices were similar between DCD and DBD HT recipients when measured around day 10 post-transplant. In particular, there were no differences in the parameters of RV dysfunction. Similarly, no differences were observed when comparing types of DCD procurement, OCS and NRP. These findings suggest that graft quality should be considered equal regardless of the type of donor or method of procurement.