Zhou Alice L, Rizaldi Alexandra A, Akbar Armaan F, Ruck Jessica M, King Elizabeth A, Kilic Ahmet
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Division of Transplant Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
J Heart Lung Transplant. 2024 Aug;43(8):1252-1262. doi: 10.1016/j.healun.2024.03.013. Epub 2024 Mar 26.
Donation after circulatory death (DCD) has reemerged as a method of expanding the donor heart pool. Given the high waitlist mortality of multiorgan heart candidates, we evaluated waitlist outcomes associated with willingness to consider DCD offers and post-transplant outcomes following DCD transplant for these candidates.
We identified adult multiorgan heart candidates and recipients between January 1, 2020 and March 31, 2023 nationally. Among candidates that met inclusion criteria, we compared the cumulative incidence of transplant, with waitlist death/deterioration as a competing risk, by willingness to consider DCD offers. Among recipients of DCD versus brain death (DBD) transplants, we compared perioperative outcomes and post-transplant survival.
Of 1,802 heart-kidney, 266 heart-liver, and 440 heart-lung candidates, 15.8%, 12.4%, and 31.1%, respectively, were willing to consider DCD offers. On adjusted analysis, willingness to consider DCD offers was associated with higher likelihood of transplant for all multiorgan heart candidates and decreased likelihood of waitlist deterioration for heart-lung candidates. Of 1,100 heart-kidney, 173 heart-liver, and 159 heart-lung recipients, 5.4%, 2.3%, and 2.5%, respectively, received DCD organs. Recipients of DCD and DBD heart-kidney transplants had a similar likelihood of perioperative outcomes and 1-year survival. All other DCD multiorgan heart recipients have survived to the last follow-up.
Multiorgan heart candidates who were willing to consider DCD offers had favorable waitlist outcomes, and heart-kidney recipients of DCD transplants had similar post-transplant outcomes to recipients of DBD transplants. We recommend the use of DCD organs to increase the donor pool for these high-risk candidates.
循环死亡后器官捐献（DCD）已重新成为扩大供心来源的一种方式。鉴于多器官心脏候选者在等待名单上的高死亡率，我们评估了与考虑接受DCD供体提议意愿相关的等待名单结局以及这些候选者接受DCD移植后的移植后结局。
我们在全国范围内确定了2020年1月1日至2023年3月31日期间的成年多器官心脏候选者和接受者。在符合纳入标准的候选者中，我们根据考虑接受DCD供体提议的意愿，比较了移植的累积发生率，并将等待名单上的死亡/病情恶化作为竞争风险。在接受DCD移植与脑死亡（DBD）移植的受者中，我们比较了围手术期结局和移植后生存率。
在1802名心肾、266名心肝和440名心肺候选者中，分别有15.8%、12.4%和31.1%愿意考虑接受DCD供体提议。经调整分析，考虑接受DCD供体提议的意愿与所有多器官心脏候选者更高的移植可能性相关，且与心肺候选者等待名单上病情恶化可能性降低相关。在1100名心肾、173名心肝和159名心肺接受者中，分别有5.4%、2.3%和2.5%接受了DCD器官。接受DCD和DBD心肾移植的受者围手术期结局和1年生存率的可能性相似。所有其他DCD多器官心脏接受者均存活至最后一次随访。
愿意考虑接受DCD供体提议的多器官心脏候选者在等待名单上有良好结局，且DCD移植的心肾接受者移植后结局与DBD移植的接受者相似。我们建议使用DCD器官来增加这些高风险候选者的供体库。
