Ex vivo heart perfusion for DCD heart transplantation with a prolonged AP

Results from an analysis of the United Network for Organ Sharing (UNOS) registry, evaluating ex vivo heart perfusion (EVHP) vs static cold storage (non-EVHP) in adult donation after circulatory death (DCD) heart transplantation, stratified by agonal period (AP) duration (N = 1,682; EVHP, n = 1,175; non-EVHP, n = 507), were published in The Journal of Heart and Lung Transplantation by Berg et al. The primary outcome was 1‑year all-cause mortality.

Key data: In multivariable analysis, non-EVHP transplants with a prolonged AP (≥30 min) had a higher risk of 1‑year mortality vs the reference group (non-EVHP + AP <30 min; hazard ratio, 2.17; p = 0.037), whereas EVHP transplants showed no increased mortality risk vs the reference group, regardless of AP duration. In propensity score-matched analysis (n = 120 per group), 1‑year survival was higher with EVHP vs non-EVHP when AP was ≥30 min (p = 0.03). Among transplants with prolonged AP, EVHP grafts had lower odds of acute rejection before discharge vs non-EVHP grafts (adjusted odds ratio, 0.39; 95% confidence interval, 0.16–0.94; p = 0.04).

Key learning: In DCD heart transplantation with a prolonged AP, EVHP may function as an early protective strategy to mitigate the survival disadvantage and increased rejection risk previously reported with prolonged agonal times.