DCD donations and outcomes of heart transplantation: the Australian experience
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REVIEW ARTICLE
DCD donations and outcomes of heart transplantation: the Australian experience Kumud Dhital 1,2 & Prakash Ludhani 3 & Sarah Scheuer 2,4 & Mark Connellan 4 & Peter Macdonald 2,4 Received: 4 April 2020 / Revised: 13 May 2020 / Accepted: 23 June 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Purpose There is increasing clinical utilization of hearts from the donation after circulatory death (DCD) pathway with the aim of expanding the donor pool and mitigating the ever-present discrepancy between the inadequate availability of good quality donor hearts and the rising number of patients with end-stage heart failure. Methods This article reviews the rationale, practice, logistical factors, and 5-year experience of DCD heart transplantation at St Vincent’s Hospital, Sydney. Findings Between July 2014 and July 2019, 69 DCD donor retrievals were undertaken resulting in 49 hearts being instrumented on an ex situ normothermic cardiac perfusion device. Seventeen (35%) of these hearts were declined and the remaining 32 (65%) were used for orthotopic DCD heart transplantation. At 5 years of follow-up, the 1-, 3-, and 5-year survival was 96%, 94%, and 94% for DCD hearts compared with 89%, 83%, and 82% respectively for donation after brain death (DBD) hearts (n.s). The immediate post-implant requirement for temporary extra-corporeal membrane oxygenation (ECMO) support for delayed graft function was 31% with no difference in rejection rates when compared with the contemporaneous cohort of patients transplanted with standard criteria DBD hearts. Summary DCD heart transplantation has become routine and incorporated into standard clinical practice by a handful of pioneering clinical transplant centres. The Australian experience demonstrates that excellent medium-term outcomes are achievable from the use of DCD hearts. These outcomes are consistent across the other centres and consequently favour a more rapid and wider uptake of heart transplantation using DCD donor hearts, which would otherwise be discarded. Keywords Donation after circulatory death . Cardiac transplantation . Extra-corporeal heart perfusion
Background Heart transplantation continues to represent the best evidencebased therapy with symptomatic and prognostic benefit for an increasing number of recipient candidates with end-stage heart * Kumud Dhital [email protected] 1
Department of Cardiothoracic Surgery & Transplantation, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
2
Transplant Laboratory, Victor Chang Cardiac Research Institute, Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW 2010, Australia
3
Department of Cardiothoracic Surgery, MIOT Hospital, Chennai, India
4
Department of Cardiothoracic Surgery, St Vincent’s Hospital, Darlinghurst, Sydney, NSW 2010, Australia
failure (HF). This includes an increasing number of HF patients who are being bridged to transplantation with mechanical circulatory support (MCS) systems. The contemporary heart transplant wait-list has consequently beco
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