Impact of Extended Travel Distances on Outcomes of Donation After Cardiac Death Heart Transplant Using Machine Perfusion

Machine perfusion (MP) is commonly used donors after circulatory death (DCD) heart transplants (HT) as direct procurement and perfusion technique, limited data exist regarding MP use for DCD donors from extended distances (ED). In the United Network for Organ Sharing (UNOS) database, 725 isolated DCD-HTs were identified between October 18, 2018, and December 31, 2023, excluding re-transplants and multi-organ transplants. Outcomes were compared according to travel distances: control (≤500 miles, n = 465) versus group ED (>500 miles, n = 260). Propensity score matching was performed (239 pairs). Travel distance was longer in group ED (224 [108–363] vs. 720 [576–903] miles; p < 0.001), as was time from cross-clamp to implantation (5.4 [3.8–6.3] vs. 6.8 [5.7–8] hours; p < 0.001). One year survival was comparable between groups (control, 92.4 ± 2.5% vs. group E, 91.8 ± 3.6%; p = 0.29). Extended distances donor was not associated with mortality (hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.43–1.53; p = 0.51). Cross-clamp-to-implantation time >8 hours was associated with mortality (reference: 0–4 hours; HR = 4.04; 95% CI = 1.50–10.86; p = 0.006), while 4–8 hours was not (HR = 1.35; 95% CI = 0.57–3.2; p = 0.497). In conclusion, DCD-HT with donors from ED using MP showed similar transplant outcomes compared with DCD-HT with donors within 500 miles. However, donor cross-clamp to implantation time >8 hours was associated with worse survival, which may be considered for donor and recipient selection.