Kwon Jennie H, Blanding Walker M, Shorbaji Khaled, Scalea Joseph R, Gibney Barry C, Baliga Prabhakar K, Kilic Arman
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC.
Ann Surg. 2023 Oct 1;278(4):609-620. doi: 10.1097/SLA.0000000000005947. Epub 2023 Jun 19.
To summarize waitlist and transplant outcomes in kidney, liver, lung, and heart transplantation using organ donation after circulatory death (DCD).
DCD has expanded the donor pool for solid organ transplantation, most recently for heart transplantation.
The United Network for Organ Sharing registry was used to identify adult transplant candidates and recipients in the most recent allocation policy eras for kidney, liver, lung, and heart transplantation. Transplant candidates and recipients were grouped by acceptance criteria for DCD versus brain-dead donors [donation after brain death (DBD)] only and DCD versus DBD transplant, respectively. Propensity matching and competing-risks regression was used to model waitlist outcomes. Survival was modeled using propensity matching and Kaplan-Meier and Cox regression analysis.
DCD transplant volumes have increased significantly across all organs. Liver candidates listed for DCD organs were more likely to undergo transplantation compared with propensity-matched candidates listed for DBD only, and heart and liver transplant candidates listed for DCD were less likely to experience death or clinical deterioration requiring waitlist inactivation. Propensity-matched DCD recipients demonstrated an increased mortality risk up to 5 years after liver and kidney transplantation and up to 3 years after lung transplantation compared with DBD. There was no difference in 1-year mortality between DCD and DBD heart transplantation.
DCD continues to expand access to transplantation and improves waitlist outcomes for liver and heart transplant candidates. Despite an increased risk for mortality with DCD kidney, liver, and lung transplantation, survival with DCD transplant remains acceptable.
总结使用循环死亡后器官捐献（DCD）进行肾、肝、肺和心脏移植时等待名单及移植结果。
DCD扩大了实体器官移植的供体库，最近也应用于心脏移植。
利用器官共享联合网络登记处，确定肾、肝、肺和心脏移植最新分配政策时期的成年移植候选者和受者。移植候选者和受者分别按对DCD与仅脑死亡供体[脑死亡后捐献（DBD）]的接受标准以及DCD与DBD移植进行分组。倾向匹配和竞争风险回归用于模拟等待名单结果。生存情况采用倾向匹配、Kaplan-Meier法和Cox回归分析进行建模。
所有器官的DCD移植量均显著增加。与仅列出DBD的倾向匹配候选者相比，列出接受DCD器官的肝移植候选者更有可能接受移植，且列出接受DCD的心脏和肝移植候选者发生死亡或临床恶化需要从等待名单中除名的可能性更小。与DBD相比，倾向匹配的DCD受者在肝和肾移植后5年内以及肺移植后3年内死亡风险增加。DCD和DBD心脏移植的1年死亡率无差异。
DCD继续扩大移植机会，并改善肝和心脏移植候选者的等待名单结果。尽管DCD肾、肝和肺移植的死亡风险增加，但DCD移植后的生存率仍可接受。
