DCDD heart transplantation with thoraco-abdominal normothermic regional perfusion and static cold storage: The experience in Spain.

Summary

In a nationwide prospective cohort across 11 centers, DCDD heart transplantation using TA-NRP with static cold storage achieved 30-day and 1-year outcomes comparable to DNDD hearts. The composite of 1-year death or severe primary graft failure was similar, and causal adjustment by inverse probability weighting confirmed no excess risk with DCDD hearts.

Key Findings

• Primary composite outcome at 1 year was similar: 21.4% (DCDD) vs 22.2% (DNDD), P=0.87.
• 30-day survival 94.9% vs 93.7% and 1-year survival 88.8% vs 87.3% for DCDD vs DNDD (P=0.70).
• Severe primary graft failure: 13.3% (DCDD) vs 15.0% (DNDD), P=0.67.
• Inverse probability weighting showed no association between DCDD and higher risk (HR 0.97, 95% CI 0.58–1.62, P=0.91).

Clinical Implications

Cardiac anesthesia and transplant teams can consider TA-NRP with static cold storage for DCDD donors, standardizing protocols for anticoagulation, perfusion management, and organ assessment, with expectation of comparable short-term outcomes to DNDD hearts.

Limitations

• Observational, nonrandomized design leaves potential residual confounding.
• Short-term outcomes reported; longer-term graft durability not assessed.

Future Directions

Evaluate long-term survival and graft function, standardize TA-NRP protocols across systems, and compare TA-NRP vs direct procurement with ex-situ perfusion platforms.