Twenty-Minute No-Touch Period Before Controlled DCD Heart Retrieval: Is There Still a Chance for Successful Recovery? The Italian Experience

Purpose: Hearts from cDCD donors are becoming an increasing source for heart transplantation (HT). Unfortunately, their use has been questioned for years in Italy given the longest-in-the-world no-touch period after death declaration (20 min). We aimed to analyze the early Italian experience using cDCD hearts for transplantation. Methods: We prospectively collected and analyzed all clinical data of all patients who underwent cDCD HT since ethical approval of the program by the National Transplant Center (CNT) (April 2023), in 5 centers which were authorized to perform cDCD HT. Results: Since April 2023, 8 cDCD HT were performed (recipient M 100%, median recipient age 58 years, IQR 44-60). Two patients were hospitalized and under inotropes before HT, no patients were on mechanical support before HT. Donor hearts (M 100%, median age 37 years, IQR 23-51) did not present any coronary lesions. Median warm ischemic time (WIT), functional WIT and asystolic time were 53min (IQR 46-62), 42min (IQR 39-44) and 28min (IQR 26-29), respectively. All the cases were performed under TA-NRP (7 CPB, 1 ECMO) through femoral vessels cannulation. No ex vivo machine perfusion devices were used. Median TA-NRP duration was 106min (IQR 86-140). Median time within TA-NRP stop and donor cardiectomy was 56min (IQR 40-126). Median cold ischemic time was 93min (IQR 78-144). Two patients required ECMO; of these, 1 patient was switched to RVAD and was finally recovered. 30-day and in-hospital mortality occurred in only 1 patient. Among the 7 alive patients, only 1 patient presented acute cellular rejection≥2 after HT. All the alive patients showed preserved ejection fraction (≥55%) and preserved RV function, with only mild tricuspid regurgitation at discharge (Table 1). Conclusion: Our preliminary data show that cDCD heart transplantation is feasible and safe also with longer donor asystolic times. Additional follow-up data and a larger cohort of patients are required to confirm these promising results.