Heart donation after circulatory death and heart donation after brain death yield similar results

Important points:

• Results were similar for donor heart transplantation after cardiovascular death and brain death donor heart transplantation.
• There were no differences between groups for serious adverse events at 30 days.

Data show that the 6-month survival rate after transplantation of donor hearts resuscitated by extracorporeal non-ischemic perfusion after cardiovascular death was similar to the 6-month survival rate after brain death donor heart transplantation.

a method known as Cardiovascular Postmortem Donation (DCD) could expand pool of available donor hearts by 30% Dr. Adam D. DeBoer, Associate Professor of Medicine, Duke University, member of the Duke Clinical Research Institute. Currently, the need for heart transplantation far outstrips the availability of suitable donor allografts. Cardiac use from DCD has been evaluated based on clinical outcomes at single centers in Australia and the UK.

“We have a lot of patients whose families want their hearts donated, but the patients don’t meet the formal criteria for brain death,” DeVore told Helio. “These are still healthy hearts and families who are still interested in donating for a heart transplant. We have had good results here, at least as good as conventional transplantation.”

Adam D. DeBoer

In a randomized, noninferiority trial, DeVore et al. analyzed data from 180 adult heart transplant candidates. These subjects were assigned to heart after donor circulatory death or heart after donor cardiac death. brain death If that heart was available first (circulatory death group, n = 90) or if only hearts preserved using conventional cold storage were available after the donor’s brain death (brain death group, n = 90).

“It’s important to realize how rare randomized clinical trials are in heart transplantation,” DeBoer said in an interview. “This was a strategy trial in which patients were randomized to either access to a DCD donor or the conventional route at enrollment. This means that only transplants from donors who have died of brain death will be accepted.If randomly assigned to the intervention, either route will result in receiving the donor heart from whichever becomes available sooner.”

The primary endpoint was risk-adjusted survival at 6 months in the treated circulatory death group compared with the brain death group. The primary safety endpoint was heart graft-related serious adverse events at 30 days post-transplant.

The survey results are New England Journal of Medicine.

Within the cohort, 166 transplant recipients were included in the treated primary analysis, including 80 hearts from circulating dead donors and 86 hearts from brain dead donors. It was

Risk-adjusted 6-month survival in the treated population was 94% (95% CI, 88-99) for heart transplants from circulatory dead donors and 90% for heart transplant recipients (95% CI, 84-97). The least squares mean difference for patients receiving heart transplants from brain dead donors was 3 percentage points, exceeding the non-inferiority margin of 20 percentage points (90% CI, 10 vs. 3. P. .001 for non-inferiority).

At 30 days post-transplant, there was no difference between groups in the mean number of heart transplant-related serious adverse events per patient.

“The data even seem to favor DCD for transplantation. Subsequent follow-up data and our own experience here at Duke University indicate that these recipients are doing very well. ‘,” said DeVore.

The potential for heart transplants with DCD could also improve the timing of transplants, says DeVore, allowing patients who need transplants to receive hearts earlier in the course of their disease, and post-transplant Said it helps with recovery.

“We talk a lot about innovation in transplantation, some of which require major advances in science or changes in existing medical structures,” DeVore told Helio. “This involves donor hearts that are already available today. Being able to expand the donor pool to

For more information:

Dr. Adam D. DeBoer, can be accessed at [email protected].