Donation after circulatory death (DCD) heart transplantation has expanded the donor pool, but concerns persist regarding the higher rates of primary graft dysfunction (PGD) observed after DCD transplantation. A propensity score-matched analysis published in the Journal of Cardiac Failure evaluated outcomes among adult heart transplant recipients in the Organ Procurement and Transplantation Network (OPTN) registry between September 2023 and July 2025. 

The analysis included 4,633 recipients after 1:3 propensity matching, comprising 1,262 DCD recipients and 3,371 donation after brain death (DBD) recipients. Severe PGD was categorized according to recovery trajectory as non-PGD, transient PGD, or persistent PGD based on support requirements at 72 hours. Multivariable Cox regression adjusted for matching covariates and ischemic time was used to assess 6-month survival outcomes. 

Findings

• Six-month survival was comparable between DCD and DBD recipients (94.3% vs 93.9%; HR 0.73; 95% CI 0.51–1.05; p = 0.09).
• Severe PGD occurred more frequently among DCD recipients than DBD recipients (11.0% vs 5.4%; p < 0.001).
• Persistent PGD corresponded with higher mortality among DCD recipients (HR 7.29; 95% CI 3.91–13.59; p < 0.001).
• Persistent PGD also corresponded with increased mortality among DBD recipients (HR 9.04; 95% CI 6.26–13.08; p < 0.001).
• The relationship between persistent PGD and mortality did not differ significantly according to donor type (interaction p = 0.375).

The analysis suggests that short-term survival after heart transplantation remained comparable between DCD and DBD recipients despite higher severe PGD rates after DCD transplantation. Outcomes appeared more closely related to PGD recovery trajectory than donor type itself.