Impact of coronary hypoperfusion during the agonal phase on outcomes following DCD heart transplantation

Results from an analysis of the United Network for Organ Sharing (UNOS) registry, evaluating the impact of coronary hypoperfusion during the agonal phase on outcomes in donation after circulatory death (DCD) heart transplant recipients (N = 696), were published in The Journal of Heart and Lung Transplantation by Hong et al. Coronary hypoperfusion was defined as diastolic blood pressure (DBP) <40 mmHg and categorized, according to the proportion of the agonal phase spent in hypoperfusion, into extensive (>20%; n = 591) or limited (≤20%; n = 105). The primary endpoint was 1-year post-transplant survival.

Key data: In the unmatched cohort, 1-year survival was lower among patients with extensive vs limited coronary hypoperfusion (91.1% vs 97.1%; p = 0.039). After multivariable adjustment, extensive hypoperfusion was independently associated with increased 1-year mortality (hazard ratio [HR], 4.01; 95% confidence interval [CI], 1.20–13.44; p = 0.024). Findings persisted in the propensity score-matched cohort (n = 103 per group), with lower 1-year survival in the extensive hypoperfusion group (89.3% vs 97.1%; p = 0.033). After multivariable adjustment, extensive hypoperfusion remained independently associated with increased 1-year mortality (HR, 4.56; 95% CI, 1.23–16.96; p = 0.024).

Key learning: Extensive coronary hypoperfusion during the agonal phase was associated with lower 1-year survival in DCD heart transplant recipients, supporting the potential role of physiologic malperfusion metrics in refining recipient risk stratification.