Division of Surgical Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
United Network for Organ Sharing, Richmond, Virginia, USA.
Am J Transplant. 2022 May;22(5):1451-1458. doi: 10.1111/ajt.16952. Epub 2022 Feb 16.
Successful normothermic machine perfusion of heart allografts (MPH) has led to rapid growth in transplantation of donation after circulatory death (DCD) heart allografts but has introduced complexity in the procurement process. This study examines the impact of MPH use in DCD procurements on warm ischemia time (WIT) and organ yield. DCD procurements from 2019 to 2020 were identified using the OPTN database. Procurements with and without the use of MPH were compared using propensity score matching. Observed to expected (O:E) yield ratios were calculated, where the expected values were obtained using the models developed by the Scientific Registry of Transplant Recipients. In total, 1237 DCD procurements met inclusion criteria (MPH: 109 and control: 1128). After PSM, no difference was found between groups in median total WIT (24.0 min vs. 24.0 min, p = .89), but the MPH group demonstrated shorter median operative WIT (circulatory arrest to cross-clamp; 8.7 min vs. 10.9 min, p = .003). The overall organ yield of DCD heart donors was observed to be 33% higher than expected (O:E 1.33; 95% CI: 1.22-1.45). Observed yield of non-heart organs was not significantly different from expected for liver, kidney, lung, and pancreas grafts. MPH use in DCD procurements does not lead to delays in WIT and does not negatively affect organ yield of other concurrently procured organs.
成功的常温机械灌注心脏移植（MPH）导致了捐赠后循环死亡（DCD）心脏移植的迅速增长，但在采购过程中增加了复杂性。本研究探讨了 DCD 采购中使用 MPH 对热缺血时间（WIT）和器官收获的影响。使用 OPTN 数据库确定了 2019 年至 2020 年的 DCD 采购情况。使用倾向评分匹配比较了使用和未使用 MPH 的采购情况。计算了观察到的与预期的（O:E）收获率比值，其中预期值是使用 Scientific Registry of Transplant Recipients 开发的模型获得的。共有 1237 例 DCD 采购符合纳入标准（MPH：109 例，对照组：1128 例）。经过 PSM，两组之间的中位总 WIT 没有差异（24.0 分钟 vs. 24.0 分钟，p = 0.89），但 MPH 组的中位手术 WIT 更短（从循环停止到阻断钳夹；8.7 分钟 vs. 10.9 分钟，p = 0.003）。DCD 心脏供体的整体器官收获率观察到比预期高 33%（O:E 为 1.33；95%CI：1.22-1.45）。肝、肾、肺和胰腺移植物的非心脏器官的实际收获率与预期无显著差异。在 DCD 采购中使用 MPH 不会导致 WIT 延迟，也不会对同时采购的其他器官的器官收获产生负面影响。
