Abstract Body (Do not enter title and authors here): Background: Deceased cardiac donor (DCD) heart transplantation has recently emerged as a safe and effective alternative to deceased brain donor (DBD) heart transplantation, with the potential to expand access and improve population-level outcomes. Despite the increasing prevalence of DCD transplants, longer-term outcomes beyond the first year are still not well characterized.

Research Question: We aimed to examine 3-year outcomes in DCD heart transplantation in a single center cohort.

Methods: All patients who underwent DCD or DBD heart transplantation between August 2019 and May 2022 were identified. Baseline donor and recipient demographic variables were collected along with outcome data at three years for overall survival, acute rejection, and cardiac allograft vasculopathy (CAV). Demographic variables were compared with a student’s T-test for continuous variables and T-test of proportions for categorical variables. Overall survival was compared using a Kaplan-Meier Curve and prevalence of acute rejection and CAV outcomes were compared using a T-test of proportions.

Results: Among 125 heart transplants performed, 47.2% (n = 59) were DCD and 52.8% (n = 66) were DBD. 74.2% of all recipients were male. DCD recipients were significantly younger, with a mean ± SD age of 53.4 ± 11.7 years compared to 57.8 ± 10.5 years in DBD recipients (p = 0.03). DCD donors were also significantly younger at 30.4 ± 7.6 years compared to DBD donors at 34.9 ± 11.7 years (p = 0.01) and more likely to be male at 82.4% ± 5.0% compared to 55.6% ± 6.3% of DBD donors (p < 0.01). Overall survival at three years was similar between DCD and DBD recipients (94.7% ± 3.0% vs 92.1% ± 3.4%, p = 0.57). Of surviving patients, 95.7% had follow-up completed through the three-year time point. There were no significant differences between DCD and DBD recipients in three-year rates of CAV (24.5% ± 5.7% vs 23.8% ± 5.4%, p = 0.99) and acute rejection (40.3% ± 6.5% vs 49.2% ± 6.3%, p = 0.43).

Conclusions: DCD heart transplantation remains a safe option compared to DBD transplant at the three-year time point in this single-center analysis with similar overall survival, and rates of CAV and acute rejection. Larger studies are still needed to generalize the longer-term efficacy of DCD transplantation.