Heart & Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, NSW, Australia; The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
Heart & Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, NSW, Australia; The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
Lancet. 2015 Jun 27;385(9987):2585-91. doi: 10.1016/S0140-6736(15)60038-1. Epub 2015 Apr 14.
Orthotopic heart transplantation is the gold-standard long-term treatment for medically refractive end-stage heart failure. However, suitable cardiac donors are scarce. Although donation after circulatory death has been used for kidney, liver, and lung transplantation, it is not used for heart transplantation. We report a case series of heart transplantations from donors after circulatory death.
The recipients were patients at St Vincent's Hospital, Sydney, Australia. They received Maastricht category III controlled hearts donated after circulatory death from people younger than 40 years and with a maximum warm ischaemic time of 30 min. We retrieved four hearts through initial myocardial protection with supplemented cardioplegia and transferred to an Organ Care System (Transmedics) for preservation, resuscitation, and transportation to the recipient hospital.
Three recipients (two men, one woman; mean age 52 years) with low transpulmonary gradients (<8 mm Hg) and without previous cardiac surgery received the transplants. Donor heart warm ischaemic times were 28 min, 25 min, and 22 min, with ex-vivo Organ Care System perfusion times of 257 min, 260 min, and 245 min. Arteriovenous lactate values at the start of perfusion were 8·3-8·1 mmol/L for patient 1, 6·79-6·48 mmol/L for patient 2, and 7·6-7·4 mmol/L for patient 3. End of perfusion lactate values were 3·6-3·6 mmol/L, 2·8-2·3 mmol/L, and 2·69-2·54 mmol/L, respectively, showing favourable lactate uptake. Two patients needed temporary mechanical support. All three recipients had normal cardiac function within a week of transplantation and are making a good recovery at 176, 91, and 77 days after transplantation.
Strict limitations on donor eligibility, optimised myocardial protection, and use of a portable ex-vivo organ perfusion platform can enable successful, distantly procured orthotopic transplantation of hearts donated after circulatory death.
NHMRC, John T Reid Charitable Trust, EVOS Trust Fund, Harry Windsor Trust Fund.
原位心脏移植是治疗医学难治性终末期心力衰竭的金标准长期治疗方法。然而，合适的心脏供体稀缺。尽管心脏停跳后捐献已用于肾、肝和肺移植，但不适用于心脏移植。我们报告了一系列心脏停跳后捐献者的心脏移植病例。
受者为澳大利亚悉尼圣文森特医院的患者。他们接受了 Maastricht 分类 III 控制性心脏移植，这些心脏来自年龄小于 40 岁、热缺血时间最长 30 分钟的心脏停跳后捐献者。我们通过补充心脏停搏液进行初始心肌保护，获取了 4 颗心脏，并将其转移至 Organ Care System（Transmedics）进行保存、复苏和运送到受体医院。
3 名受者（2 男 1 女；平均年龄 52 岁）的肺跨压较低（<8mmHg），且无既往心脏手术史，接受了移植。供心热缺血时间分别为 28 分钟、25 分钟和 22 分钟，离体 Organ Care System 灌注时间分别为 257 分钟、260 分钟和 245 分钟。灌注开始时患者 1 的动静脉乳酸值为 8.3-8.1mmol/L，患者 2 为 6.79-6.48mmol/L，患者 3 为 7.6-7.4mmol/L。灌注结束时的乳酸值分别为 3.6-3.6mmol/L、2.8-2.3mmol/L 和 2.69-2.54mmol/L，表明乳酸摄取情况良好。2 名患者需要临时机械支持。所有 3 名受者在移植后一周内心脏功能正常，移植后 176、91 和 77 天恢复良好。
严格限制供体的资格、优化心肌保护以及使用便携式体外器官灌注平台，可以成功地进行心脏停跳后捐献的远距离原位心脏移植。
NHMRC、John T Reid 慈善信托基金、EVOS 信托基金、Harry Windsor 信托基金。
Zotero 插件