Outcomes of donation after circulatory death heart transplantation in recipients with pulmonary hypertension.

BACKGROUND

Donation after circulatory death (DCD) has emerged as a strategy to expand the heart donor pool, but its safety in recipients with pulmonary hypertension (PH) remains uncertain. Because PH is a major risk factor for adverse outcomes after heart transplantation, clarifying the impact of DCD donation in this high-risk population is important.

METHODS

We analyzed adult primary heart transplant recipients with PH in the United Network for Organ Sharing registry (2019-2024). PH was defined as mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance >2 Wood units. Patients were categorized by donor type (DCD vs donation after brain death). The primary end point was 1-year all-cause mortality; secondary outcomes included acute rejection, length of stay, 1-year graft failure, and retransplant. PH severity was classified as mild, moderate, or severe, and effect modification was assessed.

RESULTS

Among 6352 recipients with PH, 489 (7.7%) received DCD hearts. DCD donation was not associated with increased 1-year mortality compared with donation after brain death (P = .22). Stratified analyses showed no significant association between donor type and mortality across PH severity strata, with no evidence of effect modification. Secondary outcomes did not differ significantly between groups.

CONCLUSIONS

In this national registry analysis, DCD heart transplantation was not associated with increased early or midterm mortality among selected recipients with pulmonary hypertension. These findings suggest that DCD donors do not appear to confer additional risk in recipients with PH and may reasonably be considered in donor selection discussions for this population.