Gao Qimeng, Pontula Arya, Alderete Isaac S, DeLaura Isabel, Kahan Riley, Nakata Kentaro, Haney John C, Klapper Jacob A, Hartwig Matthew G
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Am J Transplant. 2024 Jan;24(1):79-88. doi: 10.1016/j.ajt.2023.08.012. Epub 2023 Sep 4.
Donation after circulatory death (DCD) heart procurement is done using either direct procurement (DP) or thoracoabdominal normothermic machine perfusion (TA-NRP). Both approaches could impact lung transplant outcomes with combined heart and lung procurements from the same donor. The impact of such practice on DCD lung transplant remains unstudied. We performed a retrospective analysis using the United Network for Organ Sharing (UNOS) dataset, identifying DCD lung transplants where the donor also donated the heart (cardia lung donor [CD]). A cohort of noncardiac DCD lung donors (noncardiac lung donor [NCD]) from the same era, matched for donor and recipient characteristics, was used as a comparison group. Both immediate and long-term outcomes were examined. A subanalysis was performed comparing the distinct impact of DP or TA-NRP on DCD lung transplant outcomes. Overall graft survival did not significantly differ between CD and NCD. However, recipients in the CD group trended toward a lower P/F ratio at 72 hours (CD vs NCD: 284 vs 3190; P = .054). In the subanalysis, we identified 40 DP donors and 22 TA-NRP donors. We found the both cohorts had lower P/F ratio at 72 hours than the NCD control (P = .04). Overall, 1-year graft survival was equivalent among the TA-NRP, DP, and NCD cohorts.
循环性死亡后器官捐献（DCD）心脏获取可采用直接获取（DP）或胸腹常温机器灌注（TA-NRP）。这两种方法对于来自同一供体的心脏和肺联合获取可能会影响肺移植结果。这种做法对DCD肺移植的影响仍未得到研究。我们使用器官共享联合网络（UNOS）数据集进行了一项回顾性分析，确定了供体同时捐献心脏的DCD肺移植（心肺供体[CD]）。将同一时期、供体和受体特征相匹配的一组非心脏DCD肺供体（非心脏肺供体[NCD]）作为对照组。对近期和长期结果均进行了检查。进行了一项亚分析，比较DP或TA-NRP对DCD肺移植结果的不同影响。CD组和NCD组的总体移植物存活率无显著差异。然而，CD组受者在72小时时的P/F比值有降低趋势（CD组与NCD组：284对3190；P = 0.054）。在亚分析中，我们确定了40例DP供体和22例TA-NRP供体。我们发现这两组在72小时时的P/F比值均低于NCD对照组（P = 0.04）。总体而言，TA-NRP组、DP组和NCD组的1年移植物存活率相当。
