Department of Medicine, University of Udine, Udine, Italy.
Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Transpl Int. 2023 Jul 21;36:11089. doi: 10.3389/ti.2023.11089. eCollection 2023.
Extending selection criteria to face donor organ shortage in heart transplantation (HTx) may increase the risk of mortality. normothermic perfusion (EVP) limits ischemic time allowing assessment of graft function. We investigated the outcome of HTx in 80 high-risk recipients transplanted with marginal donor and EVP-preserved grafts, from 2016 to 2021. The recipients median age was 57 years (range, 13-75), with chronic renal failure in 61%, impaired liver function in 11% and previous cardiac surgery in 90%; 80% were mechanically supported. Median RADIAL score was 3. Mean graft ischemic time was 118 ± 25 min, "out-of-body" time 420 ± 66 min and median cardiopulmonary bypass (CPB) time 228 min (126-416). In-hospital mortality was 11% and ≥moderate primary graft dysfunction 16%. At univariable analysis, CPB time and high central venous pressure were risk factors for mortality. Actuarial survival at 1 and 3 years was 83% ± 4%, and 72% ± 7%, with a median follow-up of 16 months (range 2-43). Recipient and donor ages, pre-HTx extracorporeal life support and intra-aortic balloon pump were risk factors for late mortality. In conclusion, the use of EVP allows extension of the graft pool by recruitment of marginal donors to successfully perform HTx even in high-risk recipients.
在心脏移植 (HTx) 中扩大供体器官短缺的选择标准可能会增加死亡率。 常温灌注 (EVP) 限制了缺血时间，允许评估移植物功能。我们调查了 2016 年至 2021 年间 80 名高危接受者接受边缘供体和 EVP 保存移植物的 HTx 结果。接受者的中位年龄为 57 岁（范围 13-75 岁），其中 61%患有慢性肾衰竭，11%患有肝功能障碍，90%曾接受过心脏手术；80%接受机械支持。RADIAL 评分中位数为 3。平均移植物缺血时间为 118 ± 25 分钟，“离体”时间为 420 ± 66 分钟，心肺转流 (CPB) 中位时间为 228 分钟（126-416 分钟）。住院死亡率为 11%，≥中度原发性移植物功能障碍为 16%。在单变量分析中，CPB 时间和高中心静脉压是死亡的危险因素。1 年和 3 年的累积生存率分别为 83%±4%和 72%±7%，中位随访时间为 16 个月（范围 2-43 个月）。接受者和供者年龄、术前体外生命支持和主动脉内球囊泵是晚期死亡的危险因素。总之，EVP 的使用允许通过招募边缘供体来扩大移植物库，即使在高危接受者中也能成功进行 HTx。
