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

John Louca; Marco Öchsner; Ashish Shah; Jordan Hoffman; Francisco González Vilchez; Iris Garrido; Mario Royo-Villanova; Beatriz Domínguez-Gil; Deane 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; WISPGm; WISPG

doi:10.1016/j.eclinm.2023.101887

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

EClinicalMedicine. 2023 Mar 2:58:101887. doi: 10.1016/j.eclinm.2023.101887. eCollection 2023 Apr.

Authors

John Louca¹, Marco Öchsner¹, Ashish Shah², Jordan Hoffman², Francisco González Vilchez³, Iris Garrido⁴, Mario Royo-Villanova⁴, Beatriz Domínguez-Gil⁵, Deane Smith⁶, Leslie James⁶, Nader Moazami⁶, Filip Rega⁷, Janne Brouckaert⁷, Johan Van Cleemput⁷, Katrien Vandendriessche⁷, Vincent Tchana-Sato⁸, Diawara Bandiougou⁸, Marian Urban⁹, Alex Manara¹⁰, Marius Berman¹¹, Simon Messer¹², Stephen Large¹¹; WISPGm; WISPG

Affiliations

¹ University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK.
² Vanderbilt Heart Transplant Unit 1215, 21st Ave, Nashville, Tennessee 37232, USA.
³ Spanish Registry on Heart Transplantation, Madrid, Spain.
⁴ Hospital Universitario Virgen de La Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, Murcia 30120, Spain.
⁵ Organización Nacional de Trasplantes, Madrid, Spain.
⁶ Department of Cardiothoracic Surgery, Langone, 1300 Franklin Avenue, Suite ML-2, Garden City, NY, USA.
⁷ Departments of Cardiac Surgery and Cardiology, The University Hospital Leuven, Leuven, Belgium.
⁸ Department of Cardiovascular Surgery, CHU Liege, Liege, Belgium.
⁹ Department of Cardiothoracic Surgery, University of Nebraska Medical Centre, 2410 Atherholt Road, Omaha, NE, USA.
¹⁰ The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol BS 10 5NB, UK.
¹¹ Royal Papworth Hospital Biomedical Campus, Cambridge, CB2 0AY, UK.
¹² Golden Jubilee Hospital, Agamermnon Street, Glasgow G81 4DY, UK.

Abstract

Background: Heart 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.

Method: This 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.

Findings: taNRP 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).

Interpretation: Our 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.

Funding: None of the authors have a financial relationship with a commercial entity that has an interest in the subject.

Keywords: CS; Cold storage; DBD; DCD; Donation after brain death; Donation after circulatory determination of death; Donation after neurological death; ESMP; Ex-situ machine perfusion; Heart beating donation; In-situ perfusion; Non heart beating donation; Thoraco-abdominal nromothermic regional perfusion; taNRP.