From the Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Card Fail. 2022 Sep;28(9):1456-1463. doi: 10.1016/j.cardfail.2022.03.353. Epub 2022 Apr 18.
Heart transplantation remains the gold-standard therapy for end-stage heart failure; the expected median survival range is 12-13 years. More than 30,000 heart transplants have been performed globally in the past decade alone. With advances in medical and surgical therapies for heart failure, including durable left ventricular assist devices, an increasing number of patients are living with end-stage disease. Last year alone, more than 2500 patients were added to the heart-transplant waitlist in the United States. Despite recent efforts to expand the donor pool, including an increase in transplantation of hepatitis C-positive and extended-criteria donors, supply continues to fall short of demand. Donation after circulatory death (DCD), defined by irreversible cardiopulmonary arrest rather than donor brain death, is widely used in other solid-organ transplants, including kidney and liver, but has not been widely adopted in heart transplantation. However, resurging interest in DCD donation and the introduction of ex vivo perfusion technology has catalyzed recent clinical trials and the development of DCD heart-transplantation programs. Herein, we review the history of DCD heart transplantation, describe the currently used procurement protocols for it and examine clinical challenges and outcomes of such a procedure.
心脏移植仍然是心力衰竭终末期的金标准治疗方法；预期的中位生存范围为 12-13 年。仅在过去十年中，全球就进行了超过 30,000 次心脏移植。随着心力衰竭的医学和手术治疗的进步，包括耐用的左心室辅助装置，越来越多的患者患有终末期疾病。仅去年一年，美国就有超过 2500 名患者加入了心脏移植等待名单。尽管最近努力扩大供体库，包括增加丙型肝炎阳性和扩展标准供体的移植，但供应仍然供不应求。循环死亡后捐献（DCD）是指不可逆的心肺停止而不是供体脑死亡，广泛应用于其他实体器官移植，包括肾脏和肝脏，但在心脏移植中尚未广泛采用。然而，对 DCD 捐献的兴趣重新燃起，以及体外灌注技术的引入，推动了最近的临床试验和 DCD 心脏移植项目的发展。本文综述了 DCD 心脏移植的历史，描述了目前用于该技术的获取方案，并研究了该程序的临床挑战和结果。
