DCD heart transplantation outcomes in the US and Europe

Results from a multicenter, retrospective, ODDCAT database study, comparing outcomes of donation after circulatory death (DCD) heart transplantation (HT) performed across 22 centers in the US and Europe (Belgium, Spain, and the UK), were published in the Journal of Heart and Lung Transplantation by Louca et al. Data from 223 HT recipients in Europe and 281 in the US were analyzed. The primary outcome was survival at 1 year. 

Key data: Survival at 1 year was higher in US (n = 281) vs European (n = 223) HT recipients, (91.8% vs 86.6%; p = 0.043), while 30-day survival (97.5% vs 95.5%) and 3-year survival (79.8% vs 82.0%) were similar. Overall survival did not differ between regions (p = 0.69). Among recipients undergoing direct procurement and preservation (DPP), 1-year survival was higher in the US vs Europe (91.9% vs 82.6%; p = 0.021), whereas there was no difference in survival at any time point between regions among recipients undergoing thoracoabdominal normothermic regional perfusion (taNRP). Post-transplant mechanical circulatory support (MCS) was less common in the US vs Europe (11.0% vs 17.9%; p = 0.03). No significant differences in biopsy-proven acute cellular rejection (ACR) or rejection-free survival were observed between regions. 

Key learning: In this retrospective study, 1-year survival was higher in US vs European HT recipients; however, overall survival was comparable. These findings support the continued use of DCD HT while highlighting the need for further international data to optimize donor heart utilization and recipient outcomes.