1-year CAV risk in DCD vs DBD heart transplantation

Results from an analysis of the United Network for Organ Sharing (UNOS) registry, comparing 1-year cardiac allograft vasculopathy (CAV) in adult heart transplant recipients undergoing transplantation with donation after circulatory death (DCD; n = 1,237) vs donation after brain death (DBD; n = 11,393) hearts, were published in the American Heart Journal by Madan et al. 

Key data: The risk of CAV at 1 year was similar between DBD and DCD recipients (6.22% vs 5.90%; adjusted odds ratio [OR] 0.99; 95% confidence interval [CI], 0.77–1.28; p = 0.94) and remained similar in adjusted logistic regression (LR) models. In propensity score-matched cohorts, 1-year CAV rates were similar for DBD vs DCD-direct procurement and perfusion (DPP; 4.97% vs 5.70%; p = 0.548) and DBD vs DCD-normothermic regional perfusion (NRP; 9.63% vs 6.23%; p = 0.097).  

Key learning: These findings show that rates of CAV at 1 year were similar between DCD and DBD heart transplant recipients, irrespective of DPP or NRP procurement method, supporting continued DCD donor utilization to expand heart transplant access. However, further evaluation is needed to understand the intermediate- and long-term CAV risk in DCD heart transplant recipients.