Cardiac Allograft Vasculopathy in Heart Transplantation From Circulatory Death Donors: A Systematic Review and Meta‐Analysis

BACKGROUND: Cardiac allograft vasculopathy (CAV) remains a major cause of long-term morbidity and mortality after heart transplantation (HT). With the growing use of donation after circulatory death (DCD) donors, it is crucial to assess the incidence of CAV in this population. METHODS: We conducted a systematic review and meta-analysis of studies published between January 2010 and December 2024. comparing 1-year CAV incidence and 1-year mortality between DCD and donation after brain death (DBD) HT recipients. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using fixed and random-effects models. RESULTS: Four studies met inclusion criteria, comprising 951 HTs (576 DBD and 375 DCD). Of these, 594 HTs contributed to the CAV analysis and 914 to the mortality analysis. Pooled analysis demonstrated no significant difference in 1-year CAV incidence between DCD and DBD recipients (OR = 0.71, 95% CI: 0.43-1.17, p = 0.17). Similarly, no difference was observed in 1-year mortality (OR = 0.87, 95% CI: 0.48-1.58, p = 0.66). CONCLUSIONS: DCD and DBD-HT recipients demonstrated comparable 1-year CAV incidence and mortality. These findings support the continued and expanded use of DCD donors to address the ongoing shortage of suitable donor hearts.