Cardiac transplantation in controlled donation after circulatory death: a meta-analysis of long-term survival using reconstructed time-to-event data.

Background: Controlled donation after circulatory death (cDCD) allografts made up a small fraction of donor hearts available for transplant, however it is estimated this could increase to 30% in future years. The purpose of this systematic review and meta-analysis was to describe the largest and most up-to-date short- and long-term survival outcomes for cDCD cardiac transplantation. Methods: Three electronic databases were selected to complete the initial literature search from inception of records until February 2024. Primary outcomes were short-term survival at 12 months, as well as long-term time-to-event survival data. These data were calculated using aggregated Kaplan-Meier curves according to established methods. The secondary outcomes were acute rejection and primary graft dysfunction. Results: Following the PRISMA screening protocol, ten studies were included for analysis, eight of which were published in the last 12 months. A pooled cohort of 1,219 donor/recipient pairs were analyzed, of which all had graphical extraction of individual patient data to reveal an aggregated Kaplan-Meier curve. The survival estimates at 1, 3 and 5 years for the pooled cDCD cohort were 92.4%, 85.3% and 85.3%, respectively. In-hospital mortality rates were low at just 2.5%. Conclusions: While only making up a small percentage of current heart transplant figures, cDCD allografts may not only significantly reduce waitlist times, but could also increase the donor pool, and improve survivability over current procurement techniques. Ultimately, cDCD allografts show promise in offering an effective and favorable procurement source for cardiac transplantation worldwide.