英国全国范围内开展循环死亡后供心移植的试点项目。
A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom.
机构信息
Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Golden Jubilee University National Hospital, Glasgow, Scotland.
National Health Service Blood and Transplant, Bristol, UK.
出版信息
J Heart Lung Transplant. 2023 Aug;42(8):1120-1130. doi: 10.1016/j.healun.2023.03.006. Epub 2023 Mar 13.
BACKGROUND
The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported.
METHODS
This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum.
RESULTS
From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46).
CONCLUSION
During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.
背景
英国（UK）是最早从脑死亡供体（DBD）以外的循环死亡供体（DCD）中开展心脏移植的国家之一。为了使所有英国心脏移植中心都能公平地获得 DCD 心脏，并在全国范围内扩大检索区域，NHS 血液与移植（NHSBT）和英国国家医疗服务体系（NHSE）提供了联合创新基金（JIF）试点。本文报告了这一全国性的 DCD 心脏试点项目的活动和结果。
方法
这是一项全国性的多中心回顾性队列研究，调查了在英国 7 家心脏移植中心（成人和儿科）进行的 DCD 心脏移植的早期结果。使用直接采购和灌注（DPP）技术，由 3 支接受过离体常温机器灌注培训的专业检索团队进行检索。通过 Kaplan-Meier 分析、卡方检验和 Wilcoxon 秩和检验，将结果与国家试点前的 DCD 心脏移植和同期的 DBD 心脏移植进行比较。
结果
自 2020 年 9 月 7 日至 2022 年 2 月 28 日，共提供了 215 例潜在的 DCD 供心，其中 98 例（46%）被接受并进行了移植。共有 77 例潜在供者（36%）在 2 小时内死亡，其中 57 例（27%）供心成功进行了离体灌注，50 例（23%）DCD 供心进行了移植。在此期间，共移植了 179 例 DBD 供心。总的来说，DCD 和 DBD 的 30 天生存率（94% vs 93%）和 90 天生存率（90% vs 90%）无差异。与 DBD 相比，DCD 心脏移植后使用体外膜肺氧合（ECMO）的比例更高（40% vs 16%，p=0.0006），与 DCD 心脏移植前相比（17%，p=0.002）。两组 ICU 住院时间（DCD 组 9 天，DBD 组 8 天，p=0.13）和住院时间（DCD 组 28 天，DBD 组 27 天，p=0.46）均无差异。
结论
在该试点研究中，3 支专业检索团队能够为英国的 7 家心脏移植中心提供全国性的 DCD 心脏检索。与 DBD 供体相比，DCD 供体使英国的心脏移植总数增加了 28%，且早期移植后存活率相当。
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