Survival after heart transplants from circulatory-dead versus brain-dead donors: Meta-analysis of reconstructed time-to-event data.
Al-Tawil, M., et al.Transplantation Reviews 2025; 39(2): 100917.
Aims
This study aimed to compare posttransplant survival among donation after circulatory death (DCD) versus donation after brain (DBD) heart transplant recipients.
Interventions
Three databases including MEDLINE, Scopus and Embase were searched. The initial screening of titles and abstracts, and data extraction were peformed by two independent reviewers. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).
Participants
6 studies were included in the review.
Outcomes
The main outcome of interest was survival.
Follow-up
N/A
CET Conclusions
This interesting meta-analysis analyses at the literature comparing survival following DBD and DCD heart transplants. The authors identified 6 studies and show no survival differences in overall analysis. However, the proportional hazards assumption is violated, with more detailed landmark analysis demonstrating inferior survival following DCD transplantation from 3 years post-transplant, suggesting that longer-term outcomes may be worse in the DCD cohort. There are some limitations. The analysis relies on extraction of individual patient data from published Kaplan Meier curves, meaning that the authors are not able to correct for confounding or selection bias in those patients undergoing DCD transplant. There is also a significantly higher censoring rate in the DCD patient group. They are unable to account for recent developments in procurement methods, including normothermic regional perfusion (NRP).
Trial registration
PROSPERO - CRD42024617734