DCD donations and outcomes of heart transplantation: the Australian experience.

Dhital, K; Ludhani, P; Scheuer, S; Connellan, M; Macdonald, P

DCD donations and outcomes of heart transplantation: the Australian experience.

Dhital, K Ludhani, P Scheuer, S Connellan, M Macdonald, P

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Publisher:: Springer Science and Business Media LLC
Publication Type:: Journal Article
Citation:: Indian journal of thoracic and cardiovascular surgery, 2020, 36, (Suppl 2), pp. 224-232
Issue Date:: 2020-08-15

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Field	Value	Language
dc.contributor.author	Dhital, K
dc.contributor.author	Ludhani, P
dc.contributor.author	Scheuer, S
dc.contributor.author	Connellan, M
dc.contributor.author	Macdonald, P https://orcid.org/0000-0001-5378-2825
dc.date.accessioned	2020-12-10T02:52:01Z
dc.date.available	2020-06-23
dc.date.available	2020-12-10T02:52:01Z
dc.date.issued	2020-08-15
dc.identifier.citation	Indian journal of thoracic and cardiovascular surgery, 2020, 36, (Suppl 2), pp. 224-232
dc.identifier.issn	0970-9134
dc.identifier.issn	0973-7723
dc.identifier.uri	http://hdl.handle.net/10453/144613
dc.description.abstract	Purpose:There is increasing clinical utilization of hearts from the donation after circulatory death (DCD) pathway with the aim of expanding the donor pool and mitigating the ever-present discrepancy between the inadequate availability of good quality donor hearts and the rising number of patients with end-stage heart failure. Methods:This article reviews the rationale, practice, logistical factors, and 5-year experience of DCD heart transplantation at St Vincent's Hospital, Sydney. Findings:Between July 2014 and July 2019, 69 DCD donor retrievals were undertaken resulting in 49 hearts being instrumented on an ex situ normothermic cardiac perfusion device. Seventeen (35%) of these hearts were declined and the remaining 32 (65%) were used for orthotopic DCD heart transplantation. At 5 years of follow-up, the 1-, 3-, and 5-year survival was 96%, 94%, and 94% for DCD hearts compared with 89%, 83%, and 82% respectively for donation after brain death (DBD) hearts (n.s). The immediate post-implant requirement for temporary extra-corporeal membrane oxygenation (ECMO) support for delayed graft function was 31% with no difference in rejection rates when compared with the contemporaneous cohort of patients transplanted with standard criteria DBD hearts. Summary:DCD heart transplantation has become routine and incorporated into standard clinical practice by a handful of pioneering clinical transplant centres. The Australian experience demonstrates that excellent medium-term outcomes are achievable from the use of DCD hearts. These outcomes are consistent across the other centres and consequently favour a more rapid and wider uptake of heart transplantation using DCD donor hearts, which would otherwise be discarded.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Springer Science and Business Media LLC
dc.relation.ispartof	Indian journal of thoracic and cardiovascular surgery
dc.relation.isbasedon	10.1007/s12055-020-00998-x
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.title	DCD donations and outcomes of heart transplantation: the Australian experience.
dc.type	Journal Article
utslib.citation.volume	36
utslib.location.activity	India
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2020-12-10T02:51:58Z
pubs.issue	Suppl 2
pubs.publication-status	Published
pubs.volume	36
utslib.citation.issue	Suppl 2

Abstract:

Purpose:There is increasing clinical utilization of hearts from the donation after circulatory death (DCD) pathway with the aim of expanding the donor pool and mitigating the ever-present discrepancy between the inadequate availability of good quality donor hearts and the rising number of patients with end-stage heart failure. Methods:This article reviews the rationale, practice, logistical factors, and 5-year experience of DCD heart transplantation at St Vincent's Hospital, Sydney. Findings:Between July 2014 and July 2019, 69 DCD donor retrievals were undertaken resulting in 49 hearts being instrumented on an ex situ normothermic cardiac perfusion device. Seventeen (35%) of these hearts were declined and the remaining 32 (65%) were used for orthotopic DCD heart transplantation. At 5 years of follow-up, the 1-, 3-, and 5-year survival was 96%, 94%, and 94% for DCD hearts compared with 89%, 83%, and 82% respectively for donation after brain death (DBD) hearts (n.s). The immediate post-implant requirement for temporary extra-corporeal membrane oxygenation (ECMO) support for delayed graft function was 31% with no difference in rejection rates when compared with the contemporaneous cohort of patients transplanted with standard criteria DBD hearts. Summary:DCD heart transplantation has become routine and incorporated into standard clinical practice by a handful of pioneering clinical transplant centres. The Australian experience demonstrates that excellent medium-term outcomes are achievable from the use of DCD hearts. These outcomes are consistent across the other centres and consequently favour a more rapid and wider uptake of heart transplantation using DCD donor hearts, which would otherwise be discarded.

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http://hdl.handle.net/10453/144613