Joshi Yashutosh, Scheuer Sarah, Chew Hong, Ru Qiu Min, Soto Claudio, Villanueva Jeanette, Gao Ling, Doyle Aoife, Takahara Shingo, Jenkinson Charles, Vaidhya Nikunj, Matsumoto Yorihiko, Hwang Bridget, Zhao Christine, Iyer Arjun, Connellan Mark, Watson Alasdair, Granger Emily, Muthiah Kavitha, Jabbour Andrew, Kotlyar Eugene, Keogh Anne, Bart Nicole K, Hayward Chris, Dhital Kumud, Jansz Paul, Macdonald Peter S
Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.
Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
Transplantation. 2023 Feb 1;107(2):361-371. doi: 10.1097/TP.0000000000004294. Epub 2022 Aug 31.
Heart transplantation from donation after circulatory death (DCD) donors has the potential to substantially increase overall heart transplant activity. The aim of this report is to review the first 8 y of our clinical heart transplant program at St Vincent's Hospital Sydney, to describe how our program has evolved and to report the impact that changes to our retrieval protocols have had on posttransplant outcomes. Since 2014, we have performed 74 DCD heart transplants from DCD donors utilizing a direct procurement protocol followed by normothermic machine perfusion. Changes to our retrieval protocol have resulted in a higher retrieval rate from DCD donors and fewer rejections of DCD hearts during normothermic machine perfusion. Compared with our previously reported early experience in the first 23 transplants, we have observed a significant reduction in the incidence of severe primary graft dysfunction from 35% (8/23) to 8% (4/51) in the subsequent 51 transplant recipients ( P < 0.01). The only withdrawal time interval significantly associated with severe primary graft dysfunction was the asystolic warm ischemic time: 15 (12-17) versus 13 (11-14) min ( P < 0.05). One- and 5-y survival of DCD heart transplant recipients was 94% and 88%, comparable to that of a contemporary cohort of donation after brain death recipients: 87 and 81% ( P -value was not significant). In conclusion, heart transplantation from DCD donors has become a major contributor to our overall transplant activity accounting for almost 30% of all transplants performed by our program in the last 2 y, with similar DCD and donation after brain death outcomes.
来自循环死亡后捐赠（DCD）供体的心脏移植有潜力大幅增加心脏移植的总体活动量。本报告的目的是回顾悉尼圣文森特医院临床心脏移植项目的头8年，描述我们的项目是如何发展的，并报告我们的获取方案的改变对移植后结果产生的影响。自2014年以来，我们利用直接获取方案并随后进行常温机器灌注，从DCD供体进行了74例DCD心脏移植。我们获取方案的改变导致从DCD供体的获取率更高，且在常温机器灌注期间DCD心脏被拒收的情况更少。与我们之前报道的前23例移植的早期经验相比，我们观察到在随后的51例移植受者中，严重原发性移植物功能障碍的发生率从35%（8/23）显著降低至8%（4/51）（P<0.01）。与严重原发性移植物功能障碍显著相关的唯一撤离时间间隔是心脏停搏的热缺血时间：15（12 - 17）分钟对13（11 - 14）分钟（P<0.05）。DCD心脏移植受者1年和5年生存率分别为94%和88%，与当代脑死亡后捐赠受者队列的生存率相当：87%和81%（P值无统计学意义）。总之，来自DCD供体的心脏移植已成为我们总体移植活动的主要贡献者，在过去2年中占我们项目所进行的所有移植的近30%左右，DCD和脑死亡后捐赠的结果相似。
