Cardiac donation after circulatory death in adult congenital heart disease: Early national experiences and outcomes

Objective

Cardiac donation after circulatory death has increased in utilization with results comparable to donation after brain death in adult patients undergoing heart transplantation. However, its use in adult congenital heart disease (ACHD) is not well studied. We aimed to characterize outcomes of cardiac donation after circulatory death in an ACHD population.

Methods

Utilizing the United Network for Organ Sharing database, patients with ACHD who underwent heart transplantation between January 2020 and January 2024 were identified. Those with any prior heart transplant or undergoing multiorgan transplant were excluded. Kaplan-Meier survival analysis and Cox regression were used for group survival comparisons.

Results

A total of 420 adult patients with congenital heart disease undergoing heart transplant met inclusion criteria with 36 patients receiving donation after circulatory death grafts. Circulatory death grafts were from a similar median distance (273 vs 222 miles) but had longer ischemic times (4.7 vs 3.8 hours) and higher use of ex situ perfusion devices (66.7% vs 5.7%; P < .001). Kaplan-Meier analysis demonstrated significantly worse 90-day survival after transplant in the donation after circulatory death group (log-rank P = .039) but no difference on landmark analysis for survivors after 90 days (log-rank P = .43).

Conclusions

Early results of circulatory death grafts compared with brain death grafts in adult patients with congenital heart disease undergoing heart transplantation have demonstrated worse early survival but similar midterm survival following 90 days. Attention should be placed on improving outcomes during the perioperative period to effectively utilize this potential expanded donor pool in ACHD.