Mehta Vipin, Taylor Marcus, Hasan Joanne, Dimarakis Ioannis, Barnard Jim, Callan Paul, Shaw Steven, Venkateswaran Rajamiyer V
Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.
Cardiology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.
Interact Cardiovasc Thorac Surg. 2019 Sep 1;29(3):422-429. doi: 10.1093/icvts/ivz121.
Demand for heart transplant donors worldwide continues to outstrip supply. Transplanting hearts following donation after circulatory-determined death (DCD) is increasingly recognized as a safe and effective alternative. As the fourth centre worldwide to have established such a programme, our goal was to present our initial experience.
This was a single-centre retrospective observational study. All DCD hearts were retrieved using direct procurement and perfusion. Continuous normothermic perfusion of the procured heart was then established on the TransMedics® Organ Care System. The primary outcome of this study was the 30-day survival rate.
Between May 2017 and December 2018, 8 DCD hearts were procured and 7 were subsequently implanted, including in 2 patients who had left ventricular assist devices explanted. During the same time period, 30 patients received donation after brainstem death heart transplants. Therefore, the DCD heart transplant programme led to a 23% increase in transplant activity. The median donation warm ischaemic time was 34 min [interquartile range (IQR) 31-39 min]. The median functional warm ischaemic time was 28 min (IQR 25-30 min). The median time spent by the organ on the Organ Care System was 263 min (IQR 242-296 min). The overall 30-day survival rate was 100% and the 90-day survival rate was 86%. Postoperative extracorporeal membrane oxygenation was required in 3/7 (43%).
DCD heart transplants can lead to a 23% increase in heart transplant activity and should be adopted by more institutions across the world. Already established transplant programmes with good early outcomes can start such a programme safely.
全球范围内对心脏移植供体的需求持续超过供应。循环判定死亡（DCD）后进行心脏移植日益被认为是一种安全有效的替代方法。作为全球第四个建立此类项目的中心，我们的目标是介绍我们的初步经验。
这是一项单中心回顾性观察研究。所有DCD心脏均采用直接获取和灌注的方式进行获取。然后在TransMedics®器官护理系统上对获取的心脏进行持续常温灌注。本研究的主要结局是30天生存率。
2017年5月至2018年12月期间，共获取8例DCD心脏，随后植入7例，其中2例患者移除了左心室辅助装置。在同一时期，30例患者接受了脑死亡后心脏移植。因此，DCD心脏移植项目使移植活动增加了23%。捐赠热缺血时间中位数为34分钟[四分位间距（IQR）31 - 39分钟]。功能性热缺血时间中位数为28分钟（IQR 25 - 30分钟）。器官在器官护理系统上花费的时间中位数为263分钟（IQR 242 - 296分钟）。总体30天生存率为100%，90天生存率为86%。7例中有3例（43%）术后需要体外膜肺氧合。
DCD心脏移植可使心脏移植活动增加23%，全球更多机构应采用。已经建立且早期结果良好的移植项目可以安全地启动此类项目。
