Luckraz Heyman, Charman Susan C, Parameshwar Jayan, Tsui Steven S, Dunning John, Wallwork John, Large Stephen R
Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, UK.
J Heart Lung Transplant. 2004 Mar;23(3):330-3. doi: 10.1016/S1053-2498(02)01186-5.
The deleterious effects of brainstem death (BSD) on donor cardiac function and endothelial integrity have been documented previously. Domino cardiac donation (heart of a heart-lung recipient transplanted into another recipient) is a way to avoid the effects of brainstem death and may confer both short- and long-term benefits to allograft recipients.
This study evaluates short- and long-term outcome in heart recipients of BSD donors (cadaveric) as compared with domino hearts explanted from patients who underwent heart-lung transplantation.
Patients having undergone cardiac transplantation between April 1989 and August 2001 at Papworth Hospital were included (n = 571). Domino donor hearts were used in 81 (14%) of these cases. The pre-operative transpulmonary gradient was not significantly different between the two groups (p = 0.7). There was no significant difference in 30-day mortality (4.9% for domino vs 8.6% for BSD, p = 0.38) or in actuarial survival (p = 0.72). Ischemic time was significantly longer in the BSD group (p < 0.001). Acute rejection and infection episodes were not significantly different (p = 0.24 vs: 0.08). Relative to the BSD group, the risk (95% confidence interval) of acute rejection in the domino group was 0.89 (0.73 to 1.08). Similarly, the relative risk of infection was 0.78 (0.59 to 1.03). The 5-year actuarial survival rates (95% confidence interval) were 78% (69% to 87%) and 69% (65% to 73%) in the domino and BSD groups respectively. Angiography data at 2 years were available in 50 (62%) and 254 (52%) patients in the domino and BSD groups, respectively. The rates for 2-year freedom from cardiac allograft vasculopathy (CAV) were 96% (91% to 100%) and 93% (90% to 96%), respectively.
Despite the lack of endothelial cell activation after brainstem death and a shorter ischemic time, the performance of domino donor hearts was similar to that of BSD donor hearts. This may indicate a similar pathology (i.e., endothelial cell activation) in the domino donors.
先前已有文献记载脑干死亡（BSD）对供体心脏功能和内皮完整性的有害影响。多米诺心脏移植（将心肺移植受者的心脏移植给另一位受者）是一种避免脑干死亡影响的方法，可能会给同种异体移植受者带来短期和长期益处。
本研究评估了BSD供体（尸体供体）心脏受者与接受心肺移植患者所切除的多米诺心脏受者的短期和长期结局。
纳入了1989年4月至2001年8月在帕普沃思医院接受心脏移植的患者（n = 571）。其中81例（14%）使用了多米诺供体心脏。两组术前经肺梯度无显著差异（p = 0.7）。30天死亡率（多米诺组为4.9%，BSD组为8.6%，p = 0.38）或精算生存率无显著差异（p = 0.72）。BSD组的缺血时间明显更长（p < 0.001）。急性排斥反应和感染发作无显著差异（p = 0.24对0.08）。相对于BSD组，多米诺组急性排斥反应的风险（95%置信区间）为0.89（0.73至1.08）。同样，感染的相对风险为0.78（0.59至1.03）。多米诺组和BSD组的5年精算生存率（95%置信区间）分别为78%（69%至87%）和69%（65%至73%）。多米诺组和BSD组分别有50例（62%）和254例（52%）患者可获得2年时的血管造影数据。2年无心脏同种异体血管病变（CAV）的发生率分别为96%（91%至100%）和93%（90%至96%）。
尽管脑干死亡后缺乏内皮细胞激活且缺血时间较短，但多米诺供体心脏的表现与BSD供体心脏相似。这可能表明多米诺供体存在类似的病理情况（即内皮细胞激活）。
