Center experience is associated with greater survival following donation after circulatory death heart transplantation.

Background: Higher center volume has been associated with improved outcomes in solid organ transplantation. However, the impact of center experience on donation after circulatory death (DCD) heart transplantation outcomes remains unclear. This study evaluates the association between cumulative DCD center experience and DCD post-transplant survival.

Methods: The United Network for Organ Sharing registry was queried for adult recipients who underwent DCD heart transplantation from January 1, 2019 to December 31, 2023. Recipients were stratified by cumulative DCD center experience into low (≤10), intermediate (11-24), and high (≥25) transplant volume centers. The primary outcome was 1-year post-transplant survival. A restricted cubic spline (RCS) model was used to assess the volume-outcome relationship.

Results: A total of 1,114 DCD heart transplant recipients across 59 centers were included. Low cumulative DCD volume was associated with lower 1-year DCD post-transplant survival compared to high-volume centers when controlling for confounders (89.0% vs 92.9%, p = 0.025), independent of donation after brain death (DBD) center volume and center-level DBD post-transplant survival. RCS showed decreasing 1-year post-transplant mortality with increasing DCD volume up to 20 DCD cases, beyond which survival gains plateaued. Normothermic regional perfusion was associated with similar survival compared to direct procurement and perfusion across all center volume categories.

Conclusions: Higher cumulative DCD center experience is associated with improved 1-year DCD post-transplant survival independent of DBD center volume or performance. Survival gains plateau after approximately 20 cumulative DCD cases. These findings highlight the importance of DCD-specific institutional experience and support the expansion of DCD heart transplantation to more centers while maintaining favorable outcomes.