Donation after circulatory death (DCD) heart transplantation has promising early survival, but effects on rejection remain unclear.
The United Network for Organ Sharing (UNOS) database was queried for adult heart transplants from 12/01/2019 to 12/31/2021. Multiorgan transplants and loss to follow-up were excluded. Primary outcome was acute rejection, comparing DCD and donation after brain death (DBD) transplants.
A total of 292 DCD and 5582 DBD transplants met study criteria. Most DCD transplants were transplanted at status 3-4 (61.0%) compared to 58.6% of DBD recipients at status 1-2. DCD recipients were less likely to be hospitalized at transplant (26.7% vs 58.3%, p<0.001) and to require IABP (9.6% vs 28.9%, p<0.001), ECMO (0.3% vs 5.9%, p<0.001) or temporary LVAD (1.0% vs 2.7%, p<0.001). DCD recipients were more likely to have acute rejection prior to discharge (23.3% vs 18.4%, p=0.044) and to be hospitalized for rejection (23.4% vs 11.4%, p=0.003) at a median follow-up of 15 months; the latter remained significant after propensity-matching. On multivariable logistic regression, DCD donation was an independent predictor of acute rejection (OR 1.47, 95% CI 1.00-2.15, p=0.048) and hospitalization for rejection (OR 2.03, 95% CI 1.06-3.70, p=0.026). On center-specific subgroup analysis, DCD recipients continued to have higher rates of hospitalization for rejection (23.4% vs 13.8%, p=0.043).
DCD recipients are more likely to experience acute rejection. Early survival is similar between DCD and DBD recipients but long term implications of increased early rejection in DCD recipients requires further investigation.

Published by Elsevier Inc.