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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Early US experience with cardiac donation after circulatory death (DCD) using normothermic regional perfusion

      Background

      Given the shortage of suitable donor hearts for cardiac transplantation and the growing interest in donation after circulatory death (DCD), our institution recently began procuring cardiac allografts from DCD donors.

      Methods

      Between October 2020 and March 2021, 15 patients with heart failure underwent cardiac transplantation using DCD allografts. Allografts were procured using a modified extracorporeal membrane oxygenation circuit for thoracic normothermic regional perfusion (TA-NRP) and were subsequently transported using cold static storage. Data collection and analysis were performed with institutional review board approval.

      Results

      The mean age of the DCD donors was 23 ± 7 years and average time on TA-NRP was 56 ± 8 minutes. Total ischemic time was 183 ± 31 minutes and distance from transplant center was 373 ± 203 nautical miles. Recipient age was 55 ± 14 years, with 8 (55.3%) recipients on durable left ventricular assist device support. Post-transplant, 6 (40%) recipients experienced mild left ventricle primary graft dysfunction (PGD-LV), 3 (20%) recipients experienced moderate PGD-LV, and no recipients experienced severe PGD-LV. Postoperative transthoracic echocardiogram demonstrated left ventricular ejection fraction >55% in all recipients. One recipient (6.6%) developed International Society for Heart and Lung Transplantation 2R acute cellular rejection on first biopsy. At last follow-up, all 15 recipients were alive past 30-days.

      Conclusions

      Cardiac DCD provides an opportunity to increase the availability of donor hearts for transplantation. Utilizing TA-NRP with cold static storage, we have extended the cold ischemic time of DCD allografts to almost 3 hours, allowing for inter-hospital organ transport.

      Keywords

      Abbreviations:

      ACR (Acute cellular rejection), AMR (Antibody-mediated rejection), CAV (Cardiac allograft vasculopathy), CPB (Cardiopulmonary bypass), CRRT (Continuous renal replacement therapy), DBD (Donation after brain death), DCD (Donation after circulatory death), IABP (Intraaortic balloon pump), ISHLT (International Society for Heart and Lung Transplantation), LVAD (Left ventricular assist device), NAT (Nucleic acid amplification test), NRP (Normothermic regional perfusion), OPO (Organ procurement organization), PGD-LV (Left ventricular primary graft dysfunction), PHM (Predicted heart mass), PRA (Panel reactive antibody), TA-NRP (Thoracoabdominal normothermic regional perfusion), UNOS (United Network for Organ Sharing), VV-ECMO (Veno-venous extracorporeal membrane oxygenation), WHO (World Health Organization)
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