Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Translational Cardiothoracic Surgery Research Lab, Erasmus Medical Center, Rotterdam, The Netherlands.
Transplantation. 2022 Sep 1;106(9):1745-1753. doi: 10.1097/TP.0000000000004167. Epub 2022 May 27.
Heart transplantation (HTx) is, at present, the most effective therapy for end-stage heart failure patients; however, the number of patients on the waiting list is rising globally, further increasing the gap between demand and supply of donors for HTx. First studies using the Organ Care System (OCS) for normothermic machine perfusion show promising results yet are limited in sample size. This article presents a meta-analysis of heart donation either after brain death (OCS-DBD) or circulatory death (OCS-DCD) on using OCS versus static cold storage used for HTx.
A systematic literature search was performed for articles discussing the use of normothermic ex situ heart perfusion in adult patients. Thirty-day survival outcomes were pooled, and odds ratios were calculated using random-effects models. Long-term survival was visualized with Kaplan-Meier curves, hazard ratios were calculated and pooled using fixed-effects models, and secondary outcomes were analyzed.
A total of 12 studies were included, with 741 patients undergoing HTx, of which 260 with the OCS (173 DBD and 87 DCD). No differences were found between the 3 groups for early and late survival outcomes or for secondary outcomes.
OCS outcomes, for both DBD and DCD hearts, appeared similar as for static cold storage. Therefore, OCS is a safe and effective technique to enlarge the cardiac donor pool in both DBD and DCD, with additional benefits for long-distance transport and surgically complex procedures.
心脏移植（HTx）是目前治疗终末期心力衰竭患者最有效的方法；然而，全球范围内等待移植的患者人数不断增加，进一步加剧了 HTx 供体需求与供应之间的差距。最初使用器官保存系统（OCS）进行常温机器灌注的研究显示出有希望的结果，但样本量有限。本文对使用 OCS 进行脑死亡（OCS-DBD）或循环死亡（OCS-DCD）心脏捐献与用于 HTx 的静态低温保存进行了荟萃分析。
对讨论成人患者使用常温离体心脏灌注的文章进行了系统的文献检索。汇总了 30 天的生存结果，并使用随机效应模型计算了优势比。使用 Kaplan-Meier 曲线可视化长期生存情况，使用固定效应模型计算并汇总了风险比，并分析了次要结果。
共纳入 12 项研究，共 741 例患者接受 HTx，其中 260 例使用 OCS（173 例 DBD 和 87 例 DCD）。3 组患者在早期和晚期生存结果或次要结果方面均无差异。
OCS 对 DBD 和 DCD 心脏的结果似乎与静态低温保存相似。因此，OCS 是一种安全有效的技术，可以扩大 DBD 和 DCD 供体心脏库，同时还具有长途运输和复杂手术的额外优势。
