Adults with Congenital Heart Disease Experience Worse Outcomes Following Heart Transplantation from DCD Donors

Strategic Insights -

Adults with congenital heart disease (ACHD) undergoing isolated heart transplantation from donation-after-circulatory-death (DCD) donors experience worse short- and mid-term graft survival, according to a new study from the Stanford University School of Medicine. Researchers analyzed data from the United Network for Organ Sharing registry and found that among 726 ACHD transplants, 61 used DCD grafts and 665 used donation-after-brain-death (DBD) grafts. The study's primary endpoint was graft failure, and survival was analyzed using Kaplan-Meier curves, multivariable Cox models, and propensity-score matching.

Key Takeaways:

  • The study found that graft survival rates were significantly lower for ACHD patients receiving DCD grafts compared to DBD grafts at both 90 days and 3 years after transplantation.
  • Median ischemic times were longer for DCD grafts (5.3 hours) compared to DBD grafts (3.8 hours), with a significant difference in p<0.001.
  • The study concludes that until preservation strategies further mitigate warm-ischemic injury, careful candidate selection is warranted when allocating DCD grafts to complex ACHD patients.
  • The researchers used a 1:1 nearest-neighbor propensity-score matching method to adjust for donor and recipient age, sex, body-mass index, renal and hepatic function, support devices, listing status, prior sternotomy, and regional ACHD center volume.
  • The study's lead author, Danielle M. Mullis, noted that the findings have implications for the allocation of DCD grafts in complex ACHD patients.

Statistics:

  • Among 726 ACHD transplants, 61 (8.4%) used DCD grafts, while 665 (91.6%) used DBD grafts.
  • Baseline clinical characteristics of DCD and DBD grafts were similar, with the exception of ischemic times.
  • Graft failure rates were significantly higher for ACHD patients receiving DCD grafts (24.6% at 90 days and 35.9% at 3 years) compared to DBD grafts (14.5% at 90 days and 24.5% at 3 years).

Sources:

  • NewsRx LLC. New Congenital Heart Disease Findings from Stanford University School of Medicine Discussed (Adults with congenital heart disease experience worse short- and mid-term graft survival following heart transplantation from DCD donors: The early US ...). Cardiovascular Week. October 20, 2025; p 68.
  • Mullis, D. M., et al. (2025). Adults with congenital heart disease experience worse short- and mid-term graft survival following heart transplantation from DCD donors: The early US experience. JHLT Open, 10, 100383.