ArticleJHLT open2025
Adults with congenital heart disease experience worse short- and mid-term graft survival following heart transplantation from DCD donors: The early US experience.
Article in JHLT open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Donation after circulatory death in adult congenital heart disease: A fragile match.JHLT open · 2026Article
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9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Background: Donation-after-circulatory-death (DCD) heart procurement is enlarging the donor pool, yet its safety in adults with congenital heart disease (ACHD) is uncertain. We compared early (90-day) and mid-term (3-year) graft outcomes after DCD versus donation-after-brain-death (DBD) heart transplantation in ACHD recipients. Methods: Using the United Network for Organ Sharing registry (1 January 2018 - 1 April 2025), we identified adults (≥18 y) with ACHD undergoing isolated heart transplantation. Retransplants and multiorgan procedures were excluded. The primary endpoint was graft failure (death or retransplant). Survival was analysed with Kaplan-Meier curves, multivariable Cox models, and 1:1 nearest-neighbor propensity-score matching (caliper = 0.25 SD) adjusting for donor and recipient age, sex, body-mass index, renal and hepatic function, support devices, listing status, prior sternotomy, and regional ACHD center volume. Results: Among 726 ACHD transplants, 61 (8.4%) used DCD grafts and 665 (91.6%) used DBD grafts. Baseline clinical characteristics were similar, although DCD grafts had longer ischemic times (median 5.3 h vs 3.8 h, p < 0.001) and more frequent exvivo perfusion (65% vs 5.8%). Unadjusted 90-day and 3-year graft survival were lower after DCD (log-rank p = 0.009 and 0.040, respectively). On multivariable analysis, DCD procurement remained an independent risk factor for graft failure at 90 days (HR 2.56, 95% CI 1.23-5.17) and 3 years (HR 2.11, 95% CI 1.03-3.50).Propensity-matched analysis (n = 148) confirmed inferior 90-day survival for DCD recipients (log-rank p = 0.020). Post-operative morbidity and length of stay did not differ between groups. Conclusions: In the early US experience, ACHD recipients of DCD hearts experienced significantly worse short- and mid-term graft survival than those receiving DBD hearts, despite comparable peri-operative morbidity. Until preservation strategies further mitigate warm-ischemic injury, careful candidate selection is warranted when allocating DCD grafts to complex ACHD patients.
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