Impact of cardiopulmonary resuscitation on donation after circulatory death heart transplantation: A United Network for Organ Sharing registry analysis

Background: The criteria for evaluating donations after circulatory death (DCD) heart allografts, particularly donor cardiopulmonary resuscitation (CPR) status, remains underexplored. This study evaluates the impact of donor CPR on post-transplant outcomes in DCD heart transplants.

Methods: The UNOS registry was queried to analyze adult recipients who underwent DCD heart transplantation between 1/1/2019 and 3/31/2023, with a 1-year follow-up period extending to 3/31/2024. Primary outcomes were 90-day and 1-year post-transplant survival. 1:1 propensity score-matching was performed. Restricted cubic spline was used to model duration of CPR and likelihood of 1-year post-transplant mortality. Sub-analysis was performed to evaluate the effects of CPR duration on donor heart utilization.

Results: A total of 683 DCD recipients were included, and 378 recipients (55.3%) received hearts from donors that underwent CPR. Recipients with donors who received CPR had similar 1-year (92.1% vs 90.7%) post-transplant survival compared to recipients with donors who did not receive CPR. The comparable post-transplant survival persisted in a propensity score-matched comparison. The spline model demonstrated that longer duration of CPR was not associated with lower odds of 1-year post-transplant survival compared to the reference of 15 minutes. In the sub-analysis, longer CPR duration was not significantly associated with reduced donor heart utilization.

Conclusions: Donors that received CPR requires consideration for DCD transplants since damage during cardiac arrest prior to withdrawal of life support may amplify warm ischemic injury during procurement. This study suggests that the use of DCD hearts that underwent CPR can expand the donor pool without compromising early post-transplant survival.