Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Heart Lung Transplant. 2024 Mar;43(3):461-470. doi: 10.1016/j.healun.2023.10.013. Epub 2023 Oct 18.
Recently, several centers in the United States have begun performing donation after circulatory death (DCD) heart transplants (HTs) in adults. We sought to characterize the recent use of DCD HT, waitlist time, and outcomes compared to donation after brain death (DBD).
Using the United Network for Organ Sharing database, 10,402 adult (aged >18 years) HT recipients from January 2019 to June 2022 were identified: 425 (4%) were DCD and 9,977 (96%) were DBD recipients. Posttransplant outcomes in matched and unmatched cohorts and waitlist times were compared between groups.
DCD and DBD recipients had similar age (57 years for both, p = 0.791). DCD recipients were more likely White (67% vs 60%, p = 0.002), on left ventricular assist device (LVAD; 40% vs 32%, p < 0.001), and listed as status 4 to 6 (60% vs 24%, p < 0.001); however, less likely to require inotropes (22% vs 40%, p < 0.001) and preoperative extracorporeal membrane oxygenation (0.9% vs 6%, p < 0.001). DCD donors were younger (29 vs 32 years, p < 0.001) and had less renal dysfunction (15% vs 39%, p < 0.001), diabetes (1.9% vs 3.8%, p = 0.050), or hypertension (9.9% vs 16%, p = 0.001). In matched and unmatched cohorts, early survival was similar (p = 0.22). Adjusted waitlist time was shorter in DCD group (21 vs 31 days, p < 0.001) compared to DBD cohort and 5-fold shorter (DCD: 22 days vs DBD: 115 days, p < 0.001) for candidates in status 4 to 6, which was 60% of DCD cohort.
The community is using DCD mostly for those recipients who are expected to have extended waitlist times (e.g., durable LVADs, status >4). DCD recipients had similar posttransplant early survival and shorter adjusted waitlist time compared to DBD group. Given this early success, efforts should be made to expand the donor pool using DCD, especially for traditionally disadvantaged recipients on the waitlist.
最近，美国的几个中心已经开始在成人中进行循环死亡后捐献（DCD）心脏移植（HT）。我们试图描述最近使用 DCD HT 的情况、等待时间和结果，并与脑死亡后捐献（DBD）进行比较。
使用美国器官共享网络数据库，确定了 2019 年 1 月至 2022 年 6 月的 10402 名成年（年龄>18 岁）HT 受者：425 名（4%）为 DCD，9977 名（96%）为 DBD 受者。在匹配和不匹配队列中比较了移植后结局和等待时间，并比较了组间差异。
DCD 和 DBD 受者的年龄相似（均为 57 岁，p=0.791）。DCD 受者更可能是白人（67%比 60%，p=0.002），更可能使用左心室辅助装置（LVAD；40%比 32%，p<0.001），更可能处于状态 4 到 6（60%比 24%，p<0.001）；然而，不太可能需要正性肌力药物（22%比 40%，p<0.001）和术前体外膜氧合（0.9%比 6%，p<0.001）。DCD 供者更年轻（29 岁比 32 岁，p<0.001），肾功能障碍（15%比 39%，p<0.001）、糖尿病（1.9%比 3.8%，p=0.050）或高血压（9.9%比 16%，p=0.001）的发生率较低。在匹配和不匹配的队列中，早期存活率相似（p=0.22）。与 DBD 队列相比，DCD 组的调整后等待时间更短（21 天比 31 天，p<0.001），而状态 4 到 6 的候选者的等待时间缩短了 5 倍（DCD：22 天比 DBD：115 天，p<0.001），占 DCD 队列的 60%。
该社区主要将 DCD 用于那些预计等待时间较长的受者（例如，耐用的 LVAD、状态>4）。与 DBD 组相比，DCD 受者的移植后早期存活率相似，调整后等待时间更短。鉴于这一早期成功，应努力使用 DCD 扩大供者库，特别是为等待名单上的传统弱势群体受者。
