Intensive Care Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
Transplant Procurement Unit, Hospital Universitari de Bellvitge, Barcelona, Spain.
Transplantation. 2021 Jul 1;105(7):1482-1491. doi: 10.1097/TP.0000000000003545.
The gold-standard therapy for advanced-stage heart failure is cardiac transplantation. Since the first heart transplant in 1967, the majority of hearts transplanted came from brain death donors. Nevertheless, in recent years, the option of donation after circulatory death (DCD) is gaining importance to increase donor pool. Currently, heart-transplant programs using controlled donation after circulatory death (cDCD) have been implemented in the United Kingdom, Belgium, Australia, United States of America, and, recently, in Spain. In this article, we performed a concise review of the literature in heart cDCD; we summarize the pathophysiology involved in ischemia and reperfusion injury during this process, the different techniques of heart retrieval in cDCD donors, and the strategies that can be used to minimize the damage during retrieval and until transplantation. Heart transplant using DCD hearts is in continuous improvement and must be implemented in experienced cardiac transplant centers.
心脏移植是晚期心力衰竭的金标准治疗方法。自 1967 年首例心脏移植以来，大多数移植的心脏来自脑死亡供体。然而，近年来，通过循环死亡后捐献（DCD）的选择越来越重要，以增加供体库。目前，英国、比利时、澳大利亚、美国已经实施了使用控制性循环死亡后捐献（cDCD）的心脏移植项目，最近西班牙也开始实施。本文对心脏 cDCD 的文献进行了简明回顾；总结了这一过程中缺血再灌注损伤所涉及的病理生理学，cDCD 供体心脏采集的不同技术，以及可以用来在采集和移植过程中尽量减少损伤的策略。使用 DCD 心脏进行心脏移植正在不断改进，必须在有经验的心脏移植中心实施。
