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The international experience of in-situ recovery of the DCD heart: a multicentre retrospective observational study

2023; Elsevier BV; Volume: 58; Linguagem: Inglês

10.1016/j.eclinm.2023.101887

2589-5370

John Louca, Marco Öchsner, Ashish S. Shah, Jordan Hoffman, Alexandra Debose-Scarlett, Francisco González-Vílchez, Iris P. Garrido, Mario Royo-Villanova, Beatriz Domínguez‐Gil, Deane E. Smith, Leslie James, Nader Moazami, Filip Rega, Janne Brouckaert, Johan Van Cleemput, Katrien Vandendriessche, Vincent Tchana‐Sato, Diawara Bandiougou, Marian Urban, Alex Manara, Marius Berman, Simon Messer, Stephen Large, Nirav Patel, Rohan Sanghera, Constantinos Kapetanos, Antonio Rubino, Sai Bhagra, Luis-Alberto Martinez-Marin, Jordan Allen, Chindu John, Daniel Normington, Steven Tsui, A. Page, Vanessa Chow, William G. McMaster, Alicia Pérez‐Blanco, Elisabeth Fátima Torres, José Cuenca, Fernando Mosteiro, Marta Farrero, Elena Sandoval, Manuela Camino, Juan Miguel Gil Jaúrena, Fabrizio Sbraga, Eva Oliver, Antonio García Quintana, V. Díaz Morant, Belén Estebánez, Álvaro González, Manuel Cobo, Francisco Nistal, Manuel Gómez‐Bueno, Marina Pérez Redondo, Arne Neyrinck, Diethard Monbaliu, Laurens J. Ceulemans,

Cardiac Structural Anomalies and Repair

BackgroundHeart transplantation is an effective treatment offering the best recovery in both quality and quantity of life in those affected by refractory, severe heart failure. However, transplantation is limited by donor organ availability. The reintroduction of heart donation after the circulatory determination of death (DCD) in 2014 offered an uplift in transplant activity by 30%. Thoraco-abdominal normothermic regional perfusion (taNRP) enables in-situ reperfusion of the DCD heart. The objective of this paper is to assess the clinical outcomes of DCD donor hearts recovered and transplanted from donors undergoing taNRP.MethodThis was a multicentre retrospective observational study. Outcomes included functional warm ischaemic time, use of mechanical support immediately following transplantation, perioperative and long-term actuarial survival and incidence of acute rejection requiring treatment. 157 taNRP DCD heart transplants, performed between February 2, 2015, and July 29, 2022, have been included from 15 major transplant centres worldwide including the UK, Spain, the USA and Belgium. 673 donations after the neurological determination of death (DBD) heart transplantations from the same centres were used as a comparison group for survival.FindingstaNRP resulted in a 23% increase in heart transplantation activity. Survival was similar in the taNRP group when compared to DBD. 30-day survival was 96.8% ([92.5%–98.6%] 95% CI, n = 156), 1-year survival was 93.2% ([87.7%–96.3%] 95% CI, n = 72) and 5-year survival was 84.3% ([69.6%–92.2%] 95% CI, n = 13).InterpretationOur study suggests that taNRP provides a significant boost to heart transplantation activity. The survival rates of taNRP are comparable to those obtained for DBD transplantation in this study. The similar survival may in part be related to a short warm ischaemic time or through a possible selection bias of younger donors, this being an uncontrolled observational study. Therefore, our study suggests that taNRP offers an effective method of organ preservation and procurement. This early success of the technique warrants further investigation and use.FundingNone of the authors have a financial relationship with a commercial entity that has an interest in the subject.