Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
J Heart Lung Transplant. 2023 Jul;42(7):993-1001. doi: 10.1016/j.healun.2023.02.1497. Epub 2023 Feb 28.
The impact of donation after circulatory death (DCD) heart procurement techniques on the utilization and outcomes of concurrently procured DCD livers and kidneys remains unclear.
Using the United Network for Organ Sharing database, we identified 246 DCD donors whose heart was procured using direct procurement and ex-situ machine perfusion and 128 DCD donors whose heart was procured using in-situ thoracoabdominal normothermic regional perfusion (12/2019-03/2022). We evaluated the transplantation rate of concurrently procured DCD livers and kidneys (defined as the number of organs transplanted/total number of organs available for procurement) and their post-transplant outcomes.
The transplantation rate of concurrently procured DCD livers was higher with in-situ perfusion compared to direct procurement (67.1% vs 56.5%, p = 0.045). After excluding pediatric, multiorgan, and repeat transplant recipients, there was no difference in 6-month liver graft failure rate (direct procurement 0.9% vs in-situ perfusion 0%, p > 0.99). Recipients of kidneys procured with in-situ perfusion had less delayed graft function (11.3% vs 41.5%, p < 0.0001) shorter length of stay, and lower serum creatinine at discharge (both p < 0.05). Six-month recipient survival in the direct procurement and in-situ perfusion group were similar after DCD liver and kidney transplantation (p = 0.24 and 0.79 respectively).
Compared to direct procurement, DCD heart procurement with in-situ thoracoabdominal normothermic regional perfusion was associated with increased utilization of DCD livers and a lower incidence of delayed graft function in concurrently procured DCD kidneys. Broader implementation of DCD heart transplantation must maximize the transplant potential of concurrently procured abdominal organs and ensure their successful outcomes.
捐赠人循环死亡（DCD）心脏获取技术对同时获取的 DCD 供肝和供肾的利用率和结果的影响尚不清楚。
我们使用美国器官共享网络（United Network for Organ Sharing）数据库，确定了 246 例 DCD 供者，其心脏采用直接获取和离体机器灌注获取，128 例 DCD 供者采用原位胸腹常温区域性灌注获取（2019 年 12 月至 2022 年 3 月）。我们评估了同时获取的 DCD 供肝和供肾的移植率（定义为移植器官数量/可获取的总器官数量）及其移植后的结果。
与直接获取相比，原位灌注的同时获取 DCD 供肝的移植率更高（67.1%比 56.5%，p=0.045）。排除小儿、多器官和重复移植受者后，6 个月肝移植物失败率无差异（直接获取 0.9%比原位灌注 0%，p>0.99）。原位灌注获取的供肾受者延迟肾功能恢复（11.3%比 41.5%，p<0.0001）、住院时间较短，出院时血清肌酐水平较低（均 p<0.05）。DCD 肝和肾移植后，直接获取和原位灌注组的 6 个月受者存活率相似（p=0.24 和 0.79）。
与直接获取相比，原位胸腹常温区域性灌注获取 DCD 心脏与同时获取的 DCD 供肝利用率增加和同时获取的 DCD 供肾延迟肾功能恢复发生率降低相关。广泛实施 DCD 心脏移植必须最大限度地提高同时获取的腹部器官的移植潜力，并确保其成功结果。
