Direct Procurement with Machine Perfusion and Normothermic Regional Perfusion in Donation after Circulatory Death Heart Transplantation.

Objective: Donation after circulatory death (DCD) heart transplants have increased in US with DPP and TA-NRP techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of DCD technique on post-transplant outcomes compared to DBD donors.

Methods: Adult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023 were identified in the UNOS registry. DPP and TA-NRP cohorts were detected using time of death to aortic cross-clamp of 30 minutes. Categorical variables were compared using chi-square or Fisher exact tests, while continuous variables were compared using Mann-Whitney U tests. Propensity score matching was performed using a 1:3 match. 1-year survival was analyzed using log-rank test and Cox proportional hazard regression model.

Results: During the study period, there were 7338 DBD and 419 DCD heart transplants. At 1-year, there was no difference in survival between unmatched (p=0.13) and matched (p=0.36) DBD and DCD recipients. There was an increase in acute rejection and rejection requiring treatment in DCD compared to DBD in the matched cohort. 134 TA-NRP and 242 DPP transplants occurred. 1-year survival and post-transplant outcomes were similar in DPP and TA-NRP. TA-NRP functional warm ischemia times increased significantly during the study period.

Conclusions: In a matched cohort, DCD heart recipients experience increased acute rejection, both treated and non-treated, compared to DBD. Despite differences in the techniques, and likely functional warm ischemic times, acute rejection, survival, and other secondary outcomes are similar between DPP and TA-NRP.