• Christopher KwonYe InYIDivision of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Va. Electronic address: kwonyc@vcu.edu., Michelle Burmistrova, David T Zhu, Alan Lai, Andrew Park, Aadi Sharma, Patricia Nicolato, Zachary Fitch, Mohammed Quader, Josue Chery, Vigneshwar Kasirajan, Michael P Robich, Ahmet Kilic, and Zubair A Hashmi.
• Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Va. Electronic address: kwonyc@vcu.edu.
• J. Thorac. Cardiovasc. Surg. 2024 Dec 24.

BackgroundIn the setting of the obesity epidemic and donor organ shortage in the United States, there is a growing need to expand the donor organ eligibility criteria for orthotopic heart transplantation (OHT). Donation after circulatory death (DCD) has emerged as a promising solution, but the outcomes with obese donor hearts in DCD OHT remains unknown.MethodsUsing the United Network for Organ Sharing registry between 2019 and 2024, recipients of DCD OHT were stratified into 3 donor obesity categories by body mass index (BMI): underweight/normal (BMI <25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI >30 kg/m2). These cohorts were subgrouped by organ procurement strategy: direct procurement and preservation (DPP) or normothermic regional perfusion (NRP). Recipient and donor characteristics and risk factors for mortality were analyzed using Cox regression hazard models. Survival at 30 days, 1 year, and 5 years post-transplantation were analyzed using the Kaplan-Meier method.ResultsWe found no significant differences in patient and graft survival between donor BMI categories at all time points. Among recipients of overweight (hazard ratio [HR], 0.38; P = .0371) and obese (HR, 0.24; P = .0493) donor hearts, NRP was associated with decreased risk of mortality. Donor-recipient predicted heart mass (PHM) undermatching (defined as <86%) was associated with increased risk of mortality among underweight/normal weight donors (HR, 1.28; P = .0323) and overweight donors (HR, 1.08; P = .0382).ConclusionsDonor obesity does not confer an increased risk of recipient mortality in DCD OHT, particularly when NRP is used. PHM undermatching continues to be associated with adverse outcomes in DCD OHT.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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