Stoica Serban C, Satchithananda Duwarakan K, Charman Susan, Sharples Linda, King Robert, Rozario Chris, Dunning John, Tsui Steven S, Wallwork John, Large Stephen R
Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
J Heart Lung Transplant. 2002 Jun;21(6):615-22. doi: 10.1016/s1053-2498(02)00380-7.
High-dosage inotrope use or periods of hypotension may cause rejection of donor hearts for transplantation. At our institution, we do not refuse potential donor organs based on these criteria alone before Swan-Ganz catheter (SGC) assessment. In this study, we evaluate the role of the SGC in donor heart resuscitation and selection and assess the outcome of using borderline organs.
We retrospectively analyzed 129 donors assessed between 1996 and 1999, all with complete hemodynamic data. Two sets of SGC measurements were analyzed: one set from the initial assessments, and one set from assessments made just before organ harvesting. The physiologic targets were mean blood pressure >60 mm Hg, central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <12 mm Hg, left ventricular stroke work index >15 x g.m/m(2), and use of only one inotrope. A poorly functioning heart was defined as an organ failing on 2 or more of these criteria. Hemodynamic categories were defined as A, good function throughout assessment; B, sub-optimal function and then improvement; and C, decreasing or poor function throughout. We have a policy to avoid allocating sub-optimal organs to high-risk recipients.
One hundred fourteen donor hearts went on to be transplanted: 75 as orthotopic hearts and 39 as heart-lungs (5 of these were heart, lung, and liver transplantations, not reported further here). Of the 75 donor hearts used for heart transplantations, 53 were from Category A, 9 were from Category B, and 13 were from Category C. Of the donor hearts used for the 34 heart-lung transplantations 16 were from Category A, 10 were from Category B, and 8 were from Category C. Three patients died of donor organ failure: 1 of the corresponding hearts was from Category B, and 2 were from Category C. When comparing separately the outcome of the 2 procedures, we found no significant difference in duration of stay in the intensive care unit, requirement for mechanical support, 30-day mortality, or 1-year survival among patients with hearts from Categories A, B, and C. Ischemic time was the only significant risk factor for death (p = 0.006).
Use of organs from Categories B and C permitted expansion of the donor pool without compromising short-term outcome. However, these organs should be used with caution in combination with other risk factors, in particular long ischemic time.
高剂量使用血管活性药物或出现低血压期可能导致供体心脏移植失败。在我们机构，在进行 Swan-Ganz 导管（SGC）评估之前，我们不会仅基于这些标准就拒绝潜在的供体器官。在本研究中，我们评估了 SGC 在供体心脏复苏和选择中的作用，并评估了使用边缘器官的结果。
我们回顾性分析了 1996 年至 1999 年间评估的 129 名供体，所有供体均有完整的血流动力学数据。分析了两组 SGC 测量值：一组来自初始评估，另一组来自器官获取前的评估。生理目标为平均血压>60 mmHg、中心静脉压<12 mmHg、肺毛细血管楔压<12 mmHg、左心室每搏功指数>15 x g.m/m²，且仅使用一种血管活性药物。功能不佳的心脏定义为不符合上述 2 项或更多标准的器官。血流动力学类别定义为：A 类，整个评估过程中功能良好；B 类，功能欠佳随后改善；C 类，整个过程中功能下降或不佳。我们有一项政策，避免将功能欠佳的器官分配给高危受者。
114 个供体心脏进行了移植：75 个作为原位心脏移植，39 个作为心肺联合移植（其中 5 个是心脏、肺和肝脏联合移植，此处不再进一步报告）。在用于心脏移植的 75 个供体心脏中，53 个来自 A 类，9 个来自 B 类，13 个来自 C 类。在用于 34 例心肺联合移植的供体心脏中，16 个来自 A 类，10 个来自 B 类，8 个来自 C 类。3 例患者死于供体器官衰竭：1 例对应的心脏来自 B 类，2 例来自 C 类。分别比较这两种手术的结果时，我们发现 A 类、B 类和 C 类心脏供体的患者在重症监护病房的住院时间、机械支持需求、30 天死亡率或 1 年生存率方面没有显著差异。缺血时间是唯一显著的死亡危险因素（p = 0.006）。
使用 B 类和 C 类器官可以扩大供体库，而不影响短期结果。然而，这些器官与其他危险因素（特别是长缺血时间）联合使用时应谨慎。
