Outcomes of Donation After Circulatory Death Heart Transplantation in Australia

Hong Chee Chew; Arjun Iyer; Mark Connellan; Sarah Scheuer; Jeanette Villanueva; Ling Gao; Mark Hicks; Michelle Harkness; Claudio Soto; Andrew Dinale; Priya Nair; Alasdair Watson; Emily Granger; Paul Jansz; Kavitha Muthiah; Andrew Jabbour; Eugene Kotlyar; Anne Keogh; Chris Hayward; Robert Graham; Phillip Spratt; Peter Macdonald; Kumud Dhital

doi:10.1016/j.jacc.2018.12.067

Outcomes of Donation After Circulatory Death Heart Transplantation in Australia

J Am Coll Cardiol. 2019 Apr 2;73(12):1447-1459. doi: 10.1016/j.jacc.2018.12.067.

Authors

Hong Chee Chew¹, Arjun Iyer², Mark Connellan², Sarah Scheuer³, Jeanette Villanueva³, Ling Gao³, Mark Hicks³, Michelle Harkness³, Claudio Soto², Andrew Dinale², Priya Nair², Alasdair Watson², Emily Granger², Paul Jansz², Kavitha Muthiah², Andrew Jabbour², Eugene Kotlyar², Anne Keogh², Chris Hayward², Robert Graham³, Phillip Spratt², Peter Macdonald¹, Kumud Dhital⁴

Affiliations

¹ St. Vincent's Hospital, Sydney, New South Wales, Australia; Cardiac Transplant Laboratory, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
² St. Vincent's Hospital, Sydney, New South Wales, Australia.
³ Cardiac Transplant Laboratory, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia.
⁴ St. Vincent's Hospital, Sydney, New South Wales, Australia; Cardiac Transplant Laboratory, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: kdhital@me.com.

PMID: 30922476
DOI: 10.1016/j.jacc.2018.12.067

Abstract

Background: Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice.

Objectives: The purpose of this study is to provide an update on the authors' Australian clinical program and discuss lessons learned since performing the world's first series of distantly procured DCD heart transplants.

Methods: The authors report their experience of 23 DCD heart transplants from 45 DCD donor referrals since 2014. Donor details were collected using electronic donor records (Donate Life, Australia) and all recipient details were collected from clinical notes and electronic databases at St. Vincent's Hospital.

Results: Hearts were retrieved from 33 of 45 DCD donors. A total of 12 donors did not progress to circulatory arrest within the pre-specified timeframe. Eight hearts failed to meet viability criteria during normothermic machine perfusion, and 2 hearts were declined due to machine malfunction. A total of 23 hearts were transplanted between July 2014 and April 2018. All recipients had successful implantation, with mechanical circulatory support utilized in 9 cases. One case requiring extracorporeal membrane oxygenation subsequently died on the sixth post-operative day, representing a mortality of 4.4% over 4 years with a total follow-up period of 15,500 days for the entire cohort. All surviving recipients had normal cardiac function on echocardiogram and no evidence of acute rejection on discharge. All surviving patients remain in New York Heart Association functional class I with normal biventricular function.

Conclusions: DCD heart transplant outcomes are excellent. Despite a higher requirement for mechanical circulatory support for delayed graft function, primarily in recipients with ventricular assist device support, overall survival and rejection episodes are comparable to outcomes from contemporary brain-dead donors.

Keywords: DCD; ECMO; OCS; heart failure; heart transplant; outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Australia
Cause of Death*
Donor Selection / methods
Female
Graft Survival
Heart Transplantation* / methods
Heart Transplantation* / statistics & numerical data
Humans
Male
Outcome and Process Assessment, Health Care
Shock*
Tissue and Organ Harvesting* / methods
Tissue and Organ Harvesting* / statistics & numerical data
Tissue and Organ Procurement* / methods
Tissue and Organ Procurement* / organization & administration