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

Summary

In a nationwide prospective cohort (98 DCDD vs 347 DNDD recipients), TA-NRP with static cold storage yielded similar 30-day and 1-year outcomes and severe primary graft failure rates compared with DNDD hearts. Inverse probability weighting confirmed no association between DCDD status and the primary composite outcome.

Key Findings

• Among 98 DCDD and 347 DNDD transplants, the 1-year composite of all-cause death or severe primary graft failure was similar (21.4% vs 22.2%; P=0.87).
• Thirty-day and 1-year survival were comparable between DCDD and DNDD recipients (94.9%/88.8% vs 93.7%/87.3%; P=0.70).
• Inverse probability weighting showed no association of DCDD status with the primary endpoint (HR 0.97; 95% CI 0.58–1.62; P=0.91).

Clinical Implications

Centers can consider TA-NRP plus static cold storage for DCD heart procurement with expectations of 1-year outcomes comparable to DNDD, potentially reducing waitlist mortality.

Limitations

• Non-randomized design leaves room for residual confounding
• Short-term (1-year) outcomes; longer-term graft function and coronary allograft vasculopathy not assessed

Future Directions

Evaluate long-term outcomes (e.g., allograft vasculopathy), cost-effectiveness, and protocol optimization (TA-NRP duration, storage strategies) in randomized or carefully controlled prospective studies.