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• W4224306250 abstract "Purpose With an expanding end-stage heart failure population the demand for donor hearts is increasing. Donation after circulatory death (DCD) is a pathway that could help address this; we explore the impact of DCD over the last 8-years on our unit and compare our early vs contemporary outcomes. Methods All DCD heart transplants at our unit were included. Inclusion criteria for DCD donors are: normal transthoracic echo, age <55yrs & nil previous cardiac history. DCD heart retrievals are subject to varying functional (when systolic blood pressure drops <90mmHg) and asystolic warm ischemic times (aWIT) prior to administration of cardioplegia - this warrants an assessment of viability through visual inspection and monitoring of lactate levels. Donor hearts are cannulated onto an ex-vivo normothermic machine perfusion device where 1.2-1.5L of donor blood is circulated in a Langendorff fashion. Results Since 2014 we have performed 69 DCD heart transplants. Since 2020, DCD donors account for 32% of our heart transplant activity (32/100). Overall 1yr & 5yr survival for DCD vs BD donor heart transplant recipients was not significantly different (p=0.27). In the early experience, 12/34 patients (35.3%) required immediate post-operative ECMO or mechanical support. Recent recipients have a significantly lower rate with 3/35 (8.57%) requiring ECMO/mechanical support post-transplant (p=0.009). Mean DCD donor & recipient age was 32.6yrs(+/-10.5yrs) & 53.6yrs(+/-12.7yrs) respectively. Mean donor aWIT was 12.3mins (+/-2.8mins). Recipients of donors with an aWIT >15mins had significantly higher post-transplant ECMO/mechanical support requirement compared to those with an aWIT <=15mins (66.17% vs 17.46%, p=0.0177, OR 9.455). Median hospital length of stay was 17.5days (11-27.5days). Conclusion DCD donors can contribute to heart transplantation activity with survival comparable to BD pathways. Donor hearts subject to an aWIT >15mins are more likely to require post-operative ECMO/mechanical support. With an expanding end-stage heart failure population the demand for donor hearts is increasing. Donation after circulatory death (DCD) is a pathway that could help address this; we explore the impact of DCD over the last 8-years on our unit and compare our early vs contemporary outcomes. All DCD heart transplants at our unit were included. Inclusion criteria for DCD donors are: normal transthoracic echo, age <55yrs & nil previous cardiac history. DCD heart retrievals are subject to varying functional (when systolic blood pressure drops <90mmHg) and asystolic warm ischemic times (aWIT) prior to administration of cardioplegia - this warrants an assessment of viability through visual inspection and monitoring of lactate levels. Donor hearts are cannulated onto an ex-vivo normothermic machine perfusion device where 1.2-1.5L of donor blood is circulated in a Langendorff fashion. Since 2014 we have performed 69 DCD heart transplants. Since 2020, DCD donors account for 32% of our heart transplant activity (32/100). Overall 1yr & 5yr survival for DCD vs BD donor heart transplant recipients was not significantly different (p=0.27). In the early experience, 12/34 patients (35.3%) required immediate post-operative ECMO or mechanical support. Recent recipients have a significantly lower rate with 3/35 (8.57%) requiring ECMO/mechanical support post-transplant (p=0.009). Mean DCD donor & recipient age was 32.6yrs(+/-10.5yrs) & 53.6yrs(+/-12.7yrs) respectively. Mean donor aWIT was 12.3mins (+/-2.8mins). Recipients of donors with an aWIT >15mins had significantly higher post-transplant ECMO/mechanical support requirement compared to those with an aWIT <=15mins (66.17% vs 17.46%, p=0.0177, OR 9.455). Median hospital length of stay was 17.5days (11-27.5days). DCD donors can contribute to heart transplantation activity with survival comparable to BD pathways. Donor hearts subject to an aWIT >15mins are more likely to require post-operative ECMO/mechanical support." @default.
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• W4224306250 date "2022-04-01" @default.
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• W4224306250 title "Heart Transplantation from Donation After Circulatory Death Donors: An Update on the Australian Experience" @default.
• W4224306250 doi "https://doi.org/10.1016/j.healun.2022.01.164" @default.
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