St. Vincent's Hospital, Sydney, New South Wales, Australia; Cardiac Transplant Laboratory, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
St. Vincent's Hospital, Sydney, New South Wales, Australia.
J Am Coll Cardiol. 2019 Apr 2;73(12):1447-1459. doi: 10.1016/j.jacc.2018.12.067.
Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice.
The purpose of this study is to provide an update on the authors' Australian clinical program and discuss lessons learned since performing the world's first series of distantly procured DCD heart transplants.
The authors report their experience of 23 DCD heart transplants from 45 DCD donor referrals since 2014. Donor details were collected using electronic donor records (Donate Life, Australia) and all recipient details were collected from clinical notes and electronic databases at St. Vincent's Hospital.
Hearts were retrieved from 33 of 45 DCD donors. A total of 12 donors did not progress to circulatory arrest within the pre-specified timeframe. Eight hearts failed to meet viability criteria during normothermic machine perfusion, and 2 hearts were declined due to machine malfunction. A total of 23 hearts were transplanted between July 2014 and April 2018. All recipients had successful implantation, with mechanical circulatory support utilized in 9 cases. One case requiring extracorporeal membrane oxygenation subsequently died on the sixth post-operative day, representing a mortality of 4.4% over 4 years with a total follow-up period of 15,500 days for the entire cohort. All surviving recipients had normal cardiac function on echocardiogram and no evidence of acute rejection on discharge. All surviving patients remain in New York Heart Association functional class I with normal biventricular function.
DCD heart transplant outcomes are excellent. Despite a higher requirement for mechanical circulatory support for delayed graft function, primarily in recipients with ventricular assist device support, overall survival and rejection episodes are comparable to outcomes from contemporary brain-dead donors.
从循环死亡后捐献（DCD）供体中移植心脏是一种不断发展的临床实践。
本研究旨在提供作者澳大利亚临床项目的最新情况，并讨论自开展世界上首例远距离获取 DCD 心脏移植以来的经验教训。
作者报告了自 2014 年以来，从 45 例 DCD 供体中进行的 23 例 DCD 心脏移植的经验。使用电子供体记录（澳大利亚的 Donate Life）收集供体详细信息，并且从圣文森特医院的临床记录和电子数据库中收集所有受者详细信息。
从 45 例 DCD 供体中获取了 33 例心脏。总共有 12 例供体在规定的时间内未进展到循环停止。在常温机器灌注过程中，有 8 例心脏未达到活力标准，由于机器故障，有 2 例心脏被拒绝。2014 年 7 月至 2018 年 4 月期间共移植了 23 例心脏。所有受者均成功植入，9 例使用机械循环支持。1 例需要体外膜肺氧合的病例随后在术后第 6 天死亡，4 年死亡率为 4.4%，整个队列的总随访期为 15500 天。所有存活的受者在超声心动图上均有正常的心脏功能，出院时无急性排斥反应的证据。所有存活的患者均保持在纽约心脏协会功能 I 级，双心室功能正常。
DCD 心脏移植的结果非常出色。尽管延迟移植物功能的机械循环支持的需求较高，主要是在接受心室辅助装置支持的受者中，但总的存活率和排斥反应与同期脑死亡供体的结果相当。
