Early Outcomes of Primary Graft Dysfunction Comparing Donation After Circulatory and Brain Death Heart Transplantation: An Analysis of the UNOS Registry
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Wiley
2025
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| author | Ye In Christopher Kwon Michael Keller Kareem Elhigzi Iman Adibi Holly Caboti Jones Alan Lai Andrew Min‐Gi Park Inna F. Tchoukina Keyur B. Shah Zachary Fitch Patricia Nicolato Josue Chery Mohammed Quader Vigneshwar Kasirajan Zubair A. Hashmi |
| author_facet | Ye In Christopher Kwon Michael Keller Kareem Elhigzi Iman Adibi Holly Caboti Jones Alan Lai Andrew Min‐Gi Park Inna F. Tchoukina Keyur B. Shah Zachary Fitch Patricia Nicolato Josue Chery Mohammed Quader Vigneshwar Kasirajan Zubair A. Hashmi Ye In Christopher Kwon Michael Keller Kareem Elhigzi Iman Adibi Holly Caboti Jones Alan Lai Andrew Min‐Gi Park Inna F. Tchoukina Keyur B. Shah Zachary Fitch Patricia Nicolato Josue Chery Mohammed Quader Vigneshwar Kasirajan Zubair A. Hashmi |
| collection | Wiley Open Access |
| contents | Early Outcomes of Primary Graft Dysfunction Comparing Donation After Circulatory and Brain Death Heart Transplantation: An Analysis of the UNOS Registry Ye In Christopher Kwon Michael Keller Kareem Elhigzi Iman Adibi Holly Caboti Jones Alan Lai Andrew Min‐Gi Park Inna F. Tchoukina Keyur B. Shah Zachary Fitch Patricia Nicolato Josue Chery Mohammed Quader Vigneshwar Kasirajan Zubair A. Hashmi Clinical Transplantation ABSTRACTBackgroundPrimary graft dysfunction (PGD) represents a leading cause of mortality in patients undergoing donation after brain death (DBD) orthotopic heart transplantation (OHT), requiring timely escalation to mechanical circulatory support. There is a lack of nationwide data regarding PGD after donation after circulatory death (DCD). Here, we evaluated the incidence and short‐term outcomes of PGD following DCD.MethodsUsing the UNOS registry between 9/2023 and 9/2024, we identified all adult (≥18 years) recipients of OHT. The incidence and outcomes of moderate‐severe PGD (24‐ and 72‐h post‐transplant) were compared between DCD and DBD. Predictors for mortality after PGD were analyzed using Cox proportional hazard models. 30‐day survival was analyzed using the Kaplan‐Meier method.ResultsA total of 5017 patients underwent first‐time OHT, among whom 762 (15.2%) received DCD hearts. DCD had a significantly higher incidence of PGD at 24‐ (7.9% vs. 4.8%; p = 0.001) and 72‐h (5.9% vs. 3.3%; p = 0.001) compared to DBD. 30‐day (p = 0.3068) survival was not different between DCD and DBD patients with PGD. Similarly, for recipients with PGD at 72 h, 30‐day (p = 0.327) survival was comparable. At 72 h, DCD recipients were more likely to be supported on ECMO (p = 0.016). Transplanting DCD organs did not impact PGD‐associated mortality at 24‐ (HR 0.72, p = 0.442) and 72‐h (HR 0.74, p = 0.457). Postoperative ECMO was associated with decreased risk of PGD‐associated mortality in DCD recipients at 24‐ (p < 0.0001) and 72‐h (p < 0.0001).ConclusionsWhile PGD rates appear higher in DCD, the associated mortality remains comparable to that of DBD. Early support on ECMO may confer survival benefits in DCD recipients with PGD. 10.1111/ctr.70222 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| doi_str_mv | 10.1111/ctr.70222 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70222 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Early Outcomes of Primary Graft Dysfunction Comparing Donation After Circulatory and Brain Death Heart Transplantation: An Analysis of the UNOS Registry Ye In Christopher Kwon Michael Keller Kareem Elhigzi Iman Adibi Holly Caboti Jones Alan Lai Andrew Min‐Gi Park Inna F. Tchoukina Keyur B. Shah Zachary Fitch Patricia Nicolato Josue Chery Mohammed Quader Vigneshwar Kasirajan Zubair A. Hashmi Clinical Transplantation Early Outcomes of Primary Graft Dysfunction Comparing Donation After Circulatory and Brain Death Heart Transplantation: An Analysis of the UNOS Registry Ye In Christopher Kwon Michael Keller Kareem Elhigzi Iman Adibi Holly Caboti Jones Alan Lai Andrew Min‐Gi Park Inna F. Tchoukina Keyur B. Shah Zachary Fitch Patricia Nicolato Josue Chery Mohammed Quader Vigneshwar Kasirajan Zubair A. Hashmi Clinical Transplantation ABSTRACTBackgroundPrimary graft dysfunction (PGD) represents a leading cause of mortality in patients undergoing donation after brain death (DBD) orthotopic heart transplantation (OHT), requiring timely escalation to mechanical circulatory support. There is a lack of nationwide data regarding PGD after donation after circulatory death (DCD). Here, we evaluated the incidence and short‐term outcomes of PGD following DCD.MethodsUsing the UNOS registry between 9/2023 and 9/2024, we identified all adult (≥18 years) recipients of OHT. The incidence and outcomes of moderate‐severe PGD (24‐ and 72‐h post‐transplant) were compared between DCD and DBD. Predictors for mortality after PGD were analyzed using Cox proportional hazard models. 30‐day survival was analyzed using the Kaplan‐Meier method.ResultsA total of 5017 patients underwent first‐time OHT, among whom 762 (15.2%) received DCD hearts. DCD had a significantly higher incidence of PGD at 24‐ (7.9% vs. 4.8%; p = 0.001) and 72‐h (5.9% vs. 3.3%; p = 0.001) compared to DBD. 30‐day (p = 0.3068) survival was not different between DCD and DBD patients with PGD. Similarly, for recipients with PGD at 72 h, 30‐day (p = 0.327) survival was comparable. At 72 h, DCD recipients were more likely to be supported on ECMO (p = 0.016). Transplanting DCD organs did not impact PGD‐associated mortality at 24‐ (HR 0.72, p = 0.442) and 72‐h (HR 0.74, p = 0.457). Postoperative ECMO was associated with decreased risk of PGD‐associated mortality in DCD recipients at 24‐ (p < 0.0001) and 72‐h (p < 0.0001).ConclusionsWhile PGD rates appear higher in DCD, the associated mortality remains comparable to that of DBD. Early support on ECMO may confer survival benefits in DCD recipients with PGD. 10.1111/ctr.70222 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| title | Early Outcomes of Primary Graft Dysfunction Comparing Donation After Circulatory and Brain Death Heart Transplantation: An Analysis of the UNOS Registry |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70222 |