Outcomes of Heart Transplantation From Donation After Circulatory Death: An Up-to-Date Systematic Meta-analysis

Junjie Zong; Weicong Ye; Jizhang Yu; Xi Zhang; Jikai Cui; Zhang Chen; Yuan Li; Song Wang; Shuan Ran; Yuqing Niu; Zilong Luo; Xiaohan Li; Jiulu Zhao; Yanglin Hao; Jiahong Xia; Jie Wu

doi:10.1097/TP.0000000000005017

Outcomes of Heart Transplantation From Donation After Circulatory Death: An Up-to-Date Systematic Meta-analysis

Transplantation. 2024 Apr 5. doi: 10.1097/TP.0000000000005017. Online ahead of print.

Authors

Junjie Zong^{1

2}, Weicong Ye^{1

2}, Jizhang Yu^{1

3}, Xi Zhang^{1

3}, Jikai Cui^{1

3}, Zhang Chen^{1

2}, Yuan Li^{1

3}, Song Wang^{1

3}, Shuan Ran^{1

3}, Yuqing Niu^{1

3}, Zilong Luo^{1

3}, Xiaohan Li^{1

3}, Jiulu Zhao^{1

3}, Yanglin Hao^{1

3}, Jiahong Xia^{1

2

3

4

5

6

7}, Jie Wu^{1

2

3

4

5

6

7}

Affiliations

¹ Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
² Center for Translational Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
³ Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
⁴ Key Laboratory of Organ Transplantation, Ministry of Education, Chinese Academy of Medical Sciences, Wuhan, Hubei, China.
⁵ NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei, China.
⁶ Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei, China.
⁷ Institute of Translational Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

PMID: 38578698
DOI: 10.1097/TP.0000000000005017

Abstract

Background: Donation after circulatory death (DCD) heart transplantation (HTx) significantly expands the donor pool and reduces waitlist mortality. However, high-level evidence-based data on its safety and effectiveness are lacking. This meta-analysis aimed to compare the outcomes between DCD and donation after brain death (DBD) HTxs.

Methods: Databases, including MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, were systematically searched for randomized controlled trials and observational studies reporting the outcomes of DCD and DBD HTxs published from 2014 onward. The data were pooled using random-effects models. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the summary measures for categorical outcomes and mean differences were used for continuous outcomes.

Results: Twelve eligible studies were included in the meta-analysis. DCD HTx was associated with lower 1-y mortality rate (DCD 8.13% versus DBD 10.24%; RR = 0.75; 95% CI, 0.59-0.96; P = 0.02) and 5-y mortality rate (DCD 14.61% versus DBD 20.57%; RR = 0.72; 95% CI, 0.54-0.97; P = 0.03) compared with DBD HTx.

Conclusions: Using the current DCD criteria, HTx emerges as a promising alternative to DBD transplantation. The safety and feasibility of DCD hearts deserve further exploration and investigation.