A Comparison of postoperative hemodynamic trajectories in donation after brain death versus circulatory death heart transplantation.

BACKGROUND

Cardiac power output index (CPOi) has emerged as a prognostic marker after heart transplantation (HT), yet its application to donation after circulatory death (DCD) hearts remains unstudied. We compared early hemodynamic trajectories in DBD versus DCD HT and evaluated CPOi adjusted for vasoactive-inotropic score (CPOiVIS) as a screening tool for postoperative morbidity and mortality.

METHODS

This is a single-center retrospective study of adult heart transplants (2020-2025), excluding multiorgan transplants, congenital heart disease, and patients requiring VA-ECMO within 72 h. Hourly CPOi, VIS, CPOiVIS, right ventricular CPOi, and pulmonary artery pulsatility index were compared between groups. ROC analysis identified screening thresholds for a composite endpoint (ventilation >72 h, ICU >15 days, renal replacement therapy, or 90-day mortality). The effect of donor type on hemodynamics was assessed using multivariable regression.

RESULTS

Among 500 patients (315 DBD, 185 DCD), hemodynamic trajectories did not differ across all metrics and timepoints. CPOiVIS was the strongest predictor of the composite endpoint (AUC 0.729-0.752 at T24-T72), outperforming CPOi alone. Optimal ROC thresholds demonstrated negative predictive values of 83-89%. After adjustment for recipient creatinine, hypertension, and ischemic time, donor type had no effect on any hemodynamic parameter. The composite endpoint occurred in 27.6% of DCD versus 23.2% of DBD recipients (p = 0.285).

CONCLUSIONS

Among HT recipients who did not require early mechanical circulatory support, early allograft function did not differ significantly between DBD and DCD recipients. CPOiVIS outperformed CPOi as a screening metric for morbidity and mortality, with thresholds applicable regardless of donor type.