Extended duration of ex-vivo perfusion is associated with worse survival in donation after circulatory death heart recipients: A national database analysis

Abstract

Background

The impact of duration of ex-vivo heart perfusion (EVHP) on patient outcomes following donation after circulatory death (DCD) heart transplantation has not been established.

Methods

Adult first-time DCD heart transplants using EVHP were identified in the Organ Procurement & Transplant Network database (12/2019–09/2023). Total out of body time (OBT) was dichotomized based on perfusion duration exceeding the 90th percentile of EVHP hearts in the study. The primary outcome of 6-month mortality was assessed using Kaplan Meier curves and multivariable Cox regression. 30-day, 1-year, and 3-year mortality were also assessed. Secondary postoperative outcomes of index hospitalization length of stay, acute rejection, dialysis, and stroke were assessed using univariable linear or logistic regression.

Results

Among 575 recipients of DCD transplantations using EVHP, 58 hearts had extended perfusion times based on an OBT cutoff of 8.3 hours which identified OBT greater than the 90th percentile. Extended perfusion heart recipients had worse overall mortality at 6 months compared to standard perfusion hearts after adjusting for critical donor and recipient factors [aHR = 2.48(1.25,4.93),p = 0.009]. Early 30-day mortality was comparable between the groups (p = 0.592). However, 1-year and 3-year outcomes showed worse mortality in recipients of extended perfusion hearts (both p < 0.05). Post-transplant dialysis requirement and increased length of stay was more likely in the extended perfusion group (both p < 0.05). There was no difference in acute rejection (p = 0.163), and stroke (p = 0.170).

Conclusions

There is a potential detrimental effect of extended EVHP duration on DCD heart recipient survival. Future work will explore the identified opportunity to improve organ preservation during EVHP.