Association of posttransplant dialysis and survival after donation after circulatory death heart transplantation

Nidhi Iyanna; Brian E Woolley; Umar Nasim; Ander Dorken-Gallastegi; Gavin W Hickey; Mary E Keebler; Edward T Horn; Hernando Gómez; Yeahwa Hong; David J Kaczorowski

doi:10.1016/j.jtcvs.2026.02.012

Association of posttransplant dialysis and survival after donation after circulatory death heart transplantation

J Thorac Cardiovasc Surg. 2026 Feb 23:S0022-5223(26)00165-0. doi: 10.1016/j.jtcvs.2026.02.012. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
² Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
³ Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, Pa.
⁴ Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
⁵ Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: kaczorowskidj2@upmc.edu.

PMID: 41740883
DOI: 10.1016/j.jtcvs.2026.02.012

Abstract

Background: Renal failure is an important predictor of survival after heart transplantation. There is a paucity of literature exploring the association of renal impairment and donation after circulatory death (DCD) transplant outcomes. This study evaluated the effect of posttransplant renal failure requiring de novo dialysis on outcomes after DCD heart transplantation.

Methods: The United Network for Organ Sharing registry was queried to analyze adult DCD heart transplant recipients between January 1, 2019, and December 31, 2023. The cohort was stratified according to de novo posttransplant dialysis requirement. The primary outcome was 1-year survival. Propensity-score matching was performed. Subanalyses were untaken to explore the association with donor classification of death and procurement strategy.

Results: In total, 1122 patients who underwent DCD heart transplant were analyzed. Of these, 201 patients (17.9%) developed posttransplant renal failure requiring de novo dialysis. Recipients who received posttransplant dialysis experienced significantly lower 1-year survival compared with those without posttransplant dialysis in both the unmatched (74.2% vs 96.3%, P < .001) and matched comparisons (73.4% vs 95.0%, P < .001). DCD recipients had increased odds of posttransplant dialysis requirement compared with donation after brain death (DBD) recipients; however, 1-year survival rates between DCD and DBD recipients requiring posttransplant dialysis were comparable.

Conclusions: Renal failure requiring posttransplant de novo dialysis is a detrimental complication associated with reduced survival after DCD heart transplantation. Although the incidence of this complication is increased among DCD recipients, the survival is comparable with DBD recipients. DCD allografts can safely expand the donor pool but warrants careful evaluation of factors that increase the likelihood of posttransplant dialysis to optimize survival outcomes.

Keywords: donation after circulatory death; heart transplantation; posttransplant dialysis; renal failure.