Heart transplant experience after circulatory death. Are there differences with brain death?

Heart transplantation is an effective treatment for patients with refractory heart failure. The appearance of heart donation after death from circulatory causes (DCD) has increased the activity of heart transplantation. Our main goal is to assess the clinical findings of DCD and compare them with cardiac donation after brain death (DBD). A retrospective, single-center cohort study was carried out in the Intensive Care Unit of the Virgen de la Arrixaca Clinical Hospital. It was collected recipient outcomes, right heart catheterization measurements, inotrope scores, and echocardiography of DCD and DBD. Between January 2020 and February 2023, 13 DCD and 26 DBD hearts were transplanted. The mean age was lower in the DBD group (44.85 ± 11.9 vs 39.5 ± 12.67; p = 0.65), mostly men (69% vs 80%; p = 0.42). The median time on the waiting list was shorter for DCD 31 days [8835 days] vs 59 days [3260 days]. Heart failure due to coronary artery disease was more frequent in DBD (30% vs 53%; p = 0.3). Pulmonary hypertension before transplantation was higher in DCD (69% vs 53%; p = 0.69). Clamp time was shorter in DCD (75,1 ± 35,65 min vs 131.3 ± 78.8 min; p = 0.004), same as bypass time (87.3 ± 16.8 min vs 104.5 ± 41 min; p = 0.074). In the immediate postoperative period, extracorporeal support was required more frequently in DBDs (7 vs 11%, p = 0.709). The inotrope score was lower in DCD (33.7 ± 41.9 vs 49, ± 53.1; p = 0.345), this difference was more pronounced at 24 h (13.1 ± 18.1 vs 27.1, ± 28.05, p = 0.069). Mean total dobutamine days were lower in DCD (5.34 ± 4.7 days vs 6.08 ± 3.8 days; p = 0.6). The pulmonary artery pulsatility index on admission was lower in DCD (1.28 ± 0.76 vs 1.36 ± 0.88; p = 0.79), reversing that relationship at 24 h (1.64 ± 1.29 vs 1.06 ± 0.76, p = 0.242). The relationship between right atrial pressure and pulmonary capillary pressure was lower in DCD, accentuating this difference at 24 h (0.51 ± 0.12 vs 0.78 ± 0.29; p = 0.089). The need for continuous renal replacement therapy (CRRT) was higher in DBD (23% vs 42%; p = 0.238). Mortality was higher in DCD at 30 days (7% vs 3%; p = 1) and at 12 months (15% vs 11%; p = 0.327). Our study suggests that heart transplantation by DCD is feasible and safe. May increase the number of heart transplants with similar results to DBD.