Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA.
Am J Transplant. 2024 Jan;24(1):70-78. doi: 10.1016/j.ajt.2023.07.019. Epub 2023 Jul 28.
Heart transplantation using donation after circulatory death (DCD) was recently adopted in the United States. This study aimed to characterize organ yield from adult (≥18 years) DCD heart donors in the United States using the United Network for Organ Sharing registry. The registry does not identify potential donors who do not progress to circulatory death, and only those who progressed to death were included for analysis. Outcomes included organ recovery from the donor operating room and organ utilization for transplant. Multiple logistic regression was used to identify predictors of heart recovery and utilization. Among 558 DCD procurements, recovery occurred in 89.6%, and 92.5% of recovered hearts were utilized for transplant. Of 506 DCD procurements with available data, 65.0% were classified as direct procurement and perfusion and 35.0% were classified as normothermic regional perfusion (NRP). Logistic regression identified that NRP, shorter agonal time, younger donor age, and highest volume of organ procurement organizations were independently associated with increased odds for heart recovery. NRP independently predicted heart utilization after recovery. DCD heart utilization in the United States is satisfactory and consistent with international experience. NRP procurements have a higher yield for DCD heart transplantation compared with direct procurement and perfusion, which may reflect differences in donor assessment and acceptance criteria.
在美国，最近采用了使用循环死亡后捐献（DCD）的心脏移植。本研究旨在使用美国器官共享联合网络登记处，对美国成年（≥18 岁）DCD 心脏供体的器官产量进行特征描述。该登记处无法识别未进展到循环死亡的潜在供体，仅包括那些进展到死亡的供体进行分析。结果包括从供体手术室中获取器官和用于移植的器官利用。多变量逻辑回归用于确定心脏恢复和利用的预测因素。在 558 例 DCD 采集中，有 89.6%的供体发生了器官恢复，而 92.5%的恢复心脏用于移植。在 506 例有可用数据的 DCD 采集中，65.0%被归类为直接采集和灌注，35.0%被归类为常温区域灌注（NRP）。逻辑回归确定 NRP、较短的濒死时间、年轻的供体年龄和器官获取组织的最大容量与心脏恢复的几率增加独立相关。NRP 独立预测心脏恢复后的利用。美国 DCD 心脏的利用率令人满意，与国际经验一致。与直接采集和灌注相比，NRP 采集对 DCD 心脏移植的产量更高，这可能反映了供体评估和接受标准的差异。
