Conventional Cardiac Surgery in Donation After Circulatory Death Heart Transplantation: A United Network for Organ Sharing Registry Analysis.

OBJECTIVE

This study evaluates outcomes following donation after circulatory death (DCD) heart transplantation among recipients with prior conventional cardiac surgery.

METHODS

The UNOS registry was queried to analyze adult recipients who underwent DCD heart transplantation between 1/1/2019 and 3/31/2024. Patients with durable left ventricular assist devices or congenital heart surgery were excluded. Recipients were stratified by conventional cardiac surgical history prior to transplantation. The primary outcome was 1-year posttransplant survival. Subgroup analyses investigated the impact of surgical subtype and donor type on 1-year survival.

RESULTS

Among 785 DCD recipients included, 233 (29.7%) underwent prior conventional cardiac surgery. Conventional cardiac surgery was associated with reduced 1-year survival (89.6% vs. 96.8%, p < 0.001). Inferior survival persisted in a propensity score-matched comparison (89.0% vs. 95.3%, p = 0.02). Combined coronary revascularization and valvular interventions conferred the lowest 1-year survival rates among surgical subtypes (77.9% vs. 96.8%, p < 0.001). Among adults with conventional cardiac surgery, DCD and DBD recipients demonstrated comparable 1-year survival (aHR 0.897, 95% CI 0.57-1.40, p = 0.635).

CONCLUSION

Conventional cardiac surgical history is associated with reduced early posttransplant survival. Within this subgroup, adjusted analyses demonstrated no observed difference in early outcomes between DCD and DBD donors. These findings suggest DCD heart transplantation may be a viable strategy for organ donor pool expansion in this high-risk population.

PRACTITIONER POINTS: Growing transplant volume and waitlist demand underscore the importance of efficient, safe allograft allocation. Nearly one-third of adults undergoing DCD heart transplant have undergone prior conventional cardiac surgery. Despite lower early survival among these recipients, outcomes are independent of donor type, suggesting that use of DCD donors in this population does not confer additional mortality risk and supporting the continued utilization of DCD donors in this high-risk population.