Department of Transplantation, Royal Papworth Hospital, Papworth Everald, Cambridge, UK.
Eur J Cardiothorac Surg. 2019 Mar 1;55(3):468-475. doi: 10.1093/ejcts/ezy293.
Heart transplantation represents the most effective therapy that is currently available for end-stage heart failure. Despite the shortage of organ donors, many donor hearts are not accepted for transplantation due to poor function. Targeted donor management may increase the donor heart utilization rate. The aim of this study is to analyse a 2-year experience of early donor management through the 'scout programme' by a high-volume national cardiothoracic organ retrieval team.
A prospective cohort study was carried out between 2013 and 2015 on consecutive donation from brain-dead donors. A member of the cardiothoracic retrieval team travelled to the intensive care unit of the donor hospital to assist with early management.
One hundred and seventy-eight cardiac donors were enrolled; 106 (59.5%) were 'scouted', and 72 (40.5%) were 'non-scouted'. Donor heart utilization rate in the 'scouted' group was 47.2% (50/106) compared with 30.6% (22/72) in the 'non-scouted' group (P = 0.03). On logistic regression analysis, early donor management by the scouts independently predicted donor heart utilization. The time in the operating theatre from donor arrival to skin incision was significantly reduced in the 'scouted' group. No differences were found in the 30-day graft failure rate or the 30-day, 1-year and 2-year survival rates of the recipients between the 2 groups.
Early donor management delivered by the cardiothoracic retrieval team significantly increased the donor heart utilization rate from existing donors. Moreover, the time in the operating theatre from donor heart arrival to skin incision was significantly reduced.
心脏移植是治疗终末期心力衰竭最有效的方法。尽管器官捐献者短缺，但由于供心功能不良，许多供心不被接受移植。有针对性的供者管理可能会提高供心利用率。本研究旨在分析一个由高容量的国家心胸器官获取团队通过“侦察计划”进行的 2 年早期供者管理经验。
对 2013 年至 2015 年连续脑死亡供者的捐献进行了前瞻性队列研究。一名心胸器官获取团队成员前往供者医院的重症监护病房协助进行早期管理。
共纳入 178 例心脏供者；106 例（59.5%）为“侦察”，72 例（40.5%）为“非侦察”。在“侦察”组中，供心利用率为 47.2%（50/106），而在“非侦察”组中为 30.6%（22/72）（P=0.03）。在逻辑回归分析中，侦察员进行的早期供者管理独立预测供心利用率。在“侦察”组中，从供者到达到皮肤切开的手术时间明显缩短。两组间 30 天移植物失败率或 30 天、1 年和 2 年的受体生存率无差异。
由心胸获取团队提供的早期供者管理显著提高了现有供者的供心利用率。此外，从供心到达到皮肤切开的手术时间明显缩短。
