OUTCOMES IN DONATION AFTER CIRCULATORY DEATH CARDIAC TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS (CCC-151)

Background: Donation After Circulatory Death (DCD) donors represent a valued source of donor organs in the current setting of organ shortage. Historically, DCD donors were less preferred than Donation After Brain Death (DBD) donors for cardiac transplantation due to a warm ischemic period in the procurement process. However, recent evidence suggests that with increasing surgeon experience, improved perfusion techniques, and novel organ-care systems, DCD cardiac transplantation may be associated with similar outcomes when compared to DBD donors.

METHODS AND RESULTS: A systematic literature search for relevant articles was performed of the MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL databases from inception to January 1, 2023. Furthermore, searching of the Web of Science and Scopus registries was completed. Gray literature searches of major conference abstracts between 2021 and 2023 and of the citations of included articles were completed. Identified articles underwent independent two-stage screening for inclusion (Covidence, Veritas Health Innovation, Melbourne, Australia). Articles reporting the same patient cohorts were grouped and the most informative publication was used in this meta-analysis.

Following extraction, Stata 17 (College Station, TX, USA) was applied to conduct pairwise and proportional random-effects meta-analyses. For pairwise comparisons, weighted pooled estimates from the random-effects models were calculated with the DerSimonian-Laird method. Pooled estimates of continuous outcomes were reported as standardized mean differences (Hedge’s G).

Proportional meta-analyses involved logit transformation of continuous outcomes, inverse variance weighting, and DerSimonian-Laird estimation of the between-study variance (tau2) and subsequently the pooled effect size. Estimates of hetereogeneity were based on Mantel-Haenszel weights and these included inspection of funnel plots, the I2 statistics, and Cochran’s Q tests where applicable.

The search identified 9 studies comprising 443 DCD and 691 DBD isolated orthotopic cardiac transplant recipients (n=1134); 2 studies with pairwise comparisons were included. An additional 15 studies, though relevant, were excluded due to reporting of the same patient cohorts. Compared to DBD donors, DCD cardiac transplantation was associated with similar 30-day mortality (Risk Ratio [RR] 0.752, 95% Confidence Interval [CI]: 0.304-1.863, p=0.539), mortality at last available follow-up (RR 1.153, 95%CI: 0.655-2.030, p=0.622), and postoperative organ rejection (RR 1.225, 95%CI: 0.664-2.260, p=0.516). No significant difference in hospital length of stay was found (Hedge’s G: -0.167, 95%CI: -1.305-0.971, p=0.774).


Conclusion: DCD cardiac transplantation is associated with similar acute outcomes as cardiac transplantation from DBD donors. Additional evidence is needed to understand the role of donor type in cardiac transplantation and further randomized comparisons of donor types are required.