Traditionally, heart transplantation has relied on donors after brain death, limiting the availability of suitable donor allografts. However, the use of hearts from donors after circulatory death has gained attention. In the “Donors after Circulatory Death Heart Trial” (NCT03831048), investigators aimed to determine if reanimated hearts from circulatory death donors were noninferior to brains death donor hearts preserved with cold storage. The outcome results of this study were recently published in the New England Journal of Medicine.
In a randomized, noninferiority trial, 180 patients underwent transplantation. 90 patients received a heart donated after circulatory death and 90 patients received a heart donated after brain death. The primary endpoint was risk-adjusted survival at 6 months. Among the as-treated population, 94% survival (95% confidence interval [CI], 88 to 99)) was observed in the circulatory-death group compared to 90% (95% CI 95% CI, 84 to 97) in the brain-death group, indicating noninferiority. Whereby, the least-squares mean difference was −3 percentage points (90% CI, −10 to 3), p<0.001 for noninferiority [margin, 20 percentage points]).
Furthermore, there were no significant between-group differences in the number of serious adverse events associated with the heart graft at 30 days after transplantation. However, it is important to note that the trial’s reported results are short-term. Long-term outcomes and potential complications remain unknown. Follow-up at the five-year mark would provide better insight into the long-term implications of heart transplantation from donors after circulatory death.
This trial demonstrates that hearts obtained from circulatory death donors and reanimated using extracorporeal nonischemic perfusion are a viable alternative to standard-care transplantation with hearts preserved through cold storage after brain death. Future research is needed to assess long-term outcomes and complications associated with the transplantation of hearts obtained from donors after circulatory death.
Original article: Schroder JN, et al. N Engl J Med. 2023.