Duke University School of Medicine, Department of Medicine, Durham, North Carolina, USA.
Duke Clinical Research Institute (DCRI), Duke University School of Medicine, Durham, North Carolina, USA.
Clin Transplant. 2023 May;37(5):e14959. doi: 10.1111/ctr.14959. Epub 2023 Mar 25.
Heart transplantation (HT) has historically been limited by organ availability. Use of donation after circulatory death (DCD) donors addresses this limitation by utilizing previously unused hearts through use of the Organ Care System (OCS).
This study aimed to determine the impact of procurement and transportation method on allograft structure and function using early post-transplant cardiac magnetic resonance imaging (MRI).
Patients who underwent HT at our institution from February 1, 2020, through April 30, 2021 who underwent cardiac MRI imaging <60 days from transplant were included. Recipient and donor characteristics, clinical outcomes, and MRI findings were compared between those who underwent DCD transplantation using the OCS device (DCD-OCS), brain dead donation (DBD) using the OCS device (DBD-OCS), and DBD transported via cold storage (DBD-cold storage) using one-way analysis of variance.
A total of 85 patients underwent HT with a cardiac MRI during the study period. Thirty-one (36%) patients received a DCD organ, 16 (19%) received a DBD-OCS organ and 38 (45%) received a DBD-cold storage organ. Rates of primary graft dysfunction (PGD) were significantly higher in DCD transplants (19.5% DCD vs. .0% DBD-OCS and 5.3% DBD-cold storage; p < .050 across three groups), but with no differences in mortality or rejection. There were no differences in cardiac MRI findings between the three transplant types, including presence of gadolinium hyperenhancement after transplant (all p > .050).
We observed no differences in early cardiac MRI findings between patients that received DCD and DBD-OCS heart transplants compared with those receiving DBD-cold storage transplants.
心脏移植（HT）历来受到器官供应的限制。使用心跳停止后捐献（DCD）供体通过使用器官保存系统（OCS）利用以前未使用的心脏来解决这一限制。
本研究旨在通过早期心脏磁共振成像（MRI）确定供体采集和运输方法对同种异体结构和功能的影响。
纳入 2020 年 2 月 1 日至 2021 年 4 月 30 日期间在我院接受 HT 并在移植后<60 天内行心脏 MRI 成像的患者。使用单向方差分析比较接受使用 OCS 设备的 DCD 移植（DCD-OCS）、使用 OCS 设备的脑死亡捐献（DBD-OCS）和通过冷藏运输的 DBD（DBD-cold storage）的受者和供者特征、临床结局和 MRI 结果。
研究期间共有 85 例患者接受 HT 并进行心脏 MRI。31 例（36%）患者接受 DCD 器官，16 例（19%）接受 DBD-OCS 器官，38 例（45%）接受 DBD-cold storage 器官。DCD 移植的原发性移植物功能障碍（PGD）发生率明显更高（DCD 为 19.5%，DBD-OCS 和 DBD-cold storage 分别为 0.0%和 5.3%；三组间差异有统计学意义 p<0.050），但死亡率或排斥率无差异。三种移植类型之间的心脏 MRI 结果无差异，包括移植后钆增强的存在（所有 p>0.050）。
与接受 DBD-cold storage 移植的患者相比，接受 DCD 和 DBD-OCS 心脏移植的患者在早期心脏 MRI 发现方面无差异。
