From the Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
J Card Fail. 2023 Sep;29(9):1288-1295. doi: 10.1016/j.cardfail.2023.05.011. Epub 2023 May 23.
Heart transplantation is the gold-standard therapy for end-stage heart failure, but rates of donor-heart use remain low due to various factors that are often not evidence based. The impact of donor hemodynamics obtained via right-heart catheterization on recipient survival remains unclear.
The United Network for Organ Sharing registry was used to identify donors and recipients from September 1999-December 2019. Donor hemodynamics data were obtained and analyzed using univariate and multivariable logistical regression, with the primary endpoints being 1- and 5-year post-transplant survival.
Of the 85,333 donors who consented to heart transplantation during the study period, 6573 (7.7%) underwent right-heart catheterization, of whom 5531 eventually underwent procurement and transplantation. Donors were more likely to undergo right-heart catheterization if they had high-risk criteria. Recipients who had donor hemodynamic assessment had 1- and 5-year survival rates similar to those without donor hemodynamic assessment (87% vs 86%, 1 year). Abnormal hemodynamics were common in donor hearts but did not impact recipient survival rates, even when risk-adjusted in multivariable analysis.
Donors with abnormal hemodynamics may represent an opportunity to expand the pool of viable donor hearts.
心脏移植是治疗终末期心力衰竭的金标准疗法，但由于各种因素，供体心脏的使用率仍然较低，而这些因素往往没有依据。通过右心导管术获得的供体血流动力学对受者生存的影响尚不清楚。
利用美国器官共享联合网络注册中心的数据，于 1999 年 9 月至 2019 年 12 月期间，确定供体和受体。使用单变量和多变量逻辑回归分析获取和分析供体血流动力学数据，主要终点为移植后 1 年和 5 年的生存率。
在研究期间，有 85333 名同意进行心脏移植的供体中，有 6573 名（7.7%）接受了右心导管检查，其中 5531 名最终进行了供体心脏的获取和移植。如果供体有高危标准，则更有可能进行右心导管检查。接受供体血流动力学评估的受者 1 年和 5 年的生存率与未接受供体血流动力学评估的受者相似（87%对 86%，1 年）。供体心脏的血流动力学异常很常见，但即使在多变量分析中进行风险调整后，也不会影响受者的生存率。
血流动力学异常的供体可能代表着扩大有活力供体心脏库的机会。
