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This retrospective observational study aimed to compare clinical outcomes and demographics of donation after circulatory death (DCD) heart transplantation (HT) between European and United States (US) centers. Analyzing 504 patients across 22 international institutions, the methods involved evaluating primary (one-year survival) and secondary endpoints, namely severe primary graft dysfunction (PGD) and the incidence of acute cellular rejection.
Outcomes revealed that US recipients had higher baseline acuity (greater mechanical circulatory support utilization) and received younger donor allografts (28 years vs 37 years; p<0.001), and exhibited superior one-year survival compared to the European cohort (91.8 percent vs. 86.6 percent, p=0.043), although one-month and three-year survival rates were similar. The US cohort had a lower rate of severe PGD and higher survival in the DPP cohort at one year, although thoracoabdominal normothermic regional perfusion (TA-NRP) survival at one year was similar.
US cohorts also had significantly higher diabetic patients, shorter FWITs, longer FTITs, and longer cold storage times on ice compared to the European cohort. Nevertheless, overall longitudinal survival and rejection-free survival remained statistically equivalent between the regions. The authors conclude that DCD HT represents a safe, highly efficacious modality across both continents, with a suggestion to continue international collaboration and data collection to optimize outcomes.