The effect of warm ischemia and donor ejection fraction on 30-day mortality after donation after circulatory death heart transplantation: A national database analysis

Dane C Paneitz; Ameen M Basha; Antonia Van Kampen; Duc Giao; Jason Thomas; S Alireza Rabi; Eriberto Michel; David A D'Alessandro; Asishana A Osho

doi:10.1016/j.healun.2023.07.013

The effect of warm ischemia and donor ejection fraction on 30-day mortality after donation after circulatory death heart transplantation: A national database analysis

J Heart Lung Transplant. 2023 Nov;42(11):1493-1496. doi: 10.1016/j.healun.2023.07.013. Epub 2023 Jul 26.

Authors

Dane C Paneitz¹, Ameen M Basha², Antonia Van Kampen³, Duc Giao¹, Jason Thomas⁴, S Alireza Rabi¹, Eriberto Michel¹, David A D'Alessandro¹, Asishana A Osho⁵

Affiliations

¹ Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
² Division of Cardiac Surgery, University of Calgary, Calgary, Alberta, Canada.
³ Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
⁴ Harvard Medical School, Boston, Massachusetts.
⁵ Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: Asishana.osho@mgh.harvard.edu.

PMID: 37506954
DOI: 10.1016/j.healun.2023.07.013

Abstract

Donation after circulatory death (DCD) donor hearts recovered using the direct procurement and perfusion method experience variable durations of warm ischemia at the time of procurement (WIP). We used the Organ Procurement and Transplantation Network database to assess the effect of WIP on 30-day mortality after DCD heart transplantation. The analysis evaluated outcomes in 237 recipients of DCD heart transplantation, demonstrating an optimal WIP cut point of <36 minutes. Multivariable logistic regression modeling identified donor left ventricular ejection fraction (LVEF) <60% as an independent predictor of 30-day mortality. The area under the receiver operating characteristic curve for predicting 30-day mortality based on WIP ≥36 minutes and donor LVEF <60% was 0.90. Based on these findings, we do not recommend proceeding with DCD heart transplantation for patients with WIP ≥36 minutes, particularly in donors with LVEF <60%.

Keywords: DCD; donation after circulatory death; heart transplantation; mortality; warm ischemia.