Donation after Circulatory Death Versus Donation after Brain Death in Simultaneous Heart-kidney Transplantation: Propensity Score‐Matching

BACKGROUND We aimed to investigate outcomes of simultaneous heart-kidney (SHK) transplantation in recipients of donation after circulatory death (DCD) versus donation after brain death (DBD). METHODS The UNOS Registry was used to conduct a retrospective cohort analysis for adult recipients undergoing SHK transplantation from inception of the registry until March 2025. Recipients were stratified into two groups, DCD and DBD donors. Propensity score matching was performed using multiple variables. RESULTS After propensity score-matching, 163 recipients were included in each group. Median age was 59 in DCD and DBD groups; P = 0.483. Males were 77.9% in DCD group and 74.2% in DBD group; P = 0.532. There was no significant difference between DCD and DBD groups in terms of 1-year mortality (9.2% versus 9.8%; P = 1.0). However, transient dialysis before discharge was significantly higher in DCD group (41.4% versus 27.6%; P = 0.010). At 3 years, the stratified log rank test showed no significant difference in survival between DCD and DBD groups (84.6%, versus 83.7%; P = 0.853). DCD and DBD recipients showed no significant difference in hazard of chronic dialysis at 3 years (HR = 1.12; 95% CI=0.38–3.28; P = 0 .84). CONCLUSIONS Survival and chronic dialysis between the DCD and DBD groups in SHK transplantation were comparable at 3 years. However, early transient dialysis rate was significantly higher in the DCD group. The increased risk of transient dialysis with DCD highlights the need for adoption of preventative perioperative management strategies to mitigate this risk.