Zhou Alice L, Rizaldi Alexandra A, Ruck Jessica M, Akbar Armaan F, Kalra Andrew, Casillan Alfred J, Ha Jinny S, Merlo Christian A, Kilic Ahmet, Bush Errol L
Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins Hospital, Baltimore, Md.
J Thorac Cardiovasc Surg. 2025 Feb;169(2):505-515.e5. doi: 10.1016/j.jtcvs.2024.07.008. Epub 2024 Jul 14.
Concomitant heart and lung recovery can result in increased operative complexity, ischemic time, and competition for resources and anatomic territory. Dual thoracic recovery from circulatory death donors may have additional risks that are not fully understood. We investigated the effects of dual heart and lung recovery from circulatory death donors on thoracic transplant outcomes.
Using the United Network for Organ Sharing database, we categorized all adult thoracic circulatory death donor transplants from 2019 to 2023 by whether the donor heart, lung, or both (dual donors) were recovered. Heart and lung transplant outcomes were compared between dual recovery donors and heart-only or lung-only donors, respectively, using multivariable analyses.
Of the 2513 donors included, 42.9% were heart-only, 45.0% were lung-only, and 12.0% were dual donors. Recipients of dual versus heart-only donors had similar likelihood of post-transplant dialysis (18.9% vs 18.3%, P = .84), likelihood of stroke (2.9% vs 4.7%, P = .34), and 2-year risk of mortality (adjusted hazard ratio, 1.15 [95% CI, 0.90-1.47], P = .26), but lower likelihood of acute rejection (10.2% vs 16.1%, P = .04). Recipients of dual and lung-only donors had similar likelihood of predischarge acute rejection (7.6% vs 8.5%, P = .70), intubation at 72 hours (38.9% vs 45.1%, P = .13), and extracorporeal membrane oxygenation at 72 hours (13.1% vs 18.1%, P = .11), as well as 2-year risk of mortality (adjusted hazard ratio, 1.16 [95% CI, 0.74-1.82], P = .52).
Recovering both the heart and lungs from a circulatory death donor does not negatively impact transplant outcomes. Outcomes in this population should continue to be investigated as more data and longer-term follow-up become available.
心肺联合复苏可导致手术复杂性增加、缺血时间延长以及资源和解剖区域的竞争。从循环死亡供体进行双肺移植可能存在一些尚未完全了解的额外风险。我们研究了从循环死亡供体进行心肺联合复苏对胸段移植结局的影响。
利用器官共享联合网络数据库，我们根据是否获取供体心脏、肺或两者（双供体），对2019年至2023年所有成年胸段循环死亡供体移植进行了分类。分别使用多变量分析比较了双肺复苏供体与仅心脏或仅肺供体的心肺移植结局。
在纳入的2513名供体中，42.9%为仅心脏供体，45.0%为仅肺供体，12.0%为双供体。双供体与仅心脏供体的受者术后透析的可能性相似（18.9%对18.3%，P = 0.84），中风的可能性相似（2.9%对4.7%，P = 0.34），以及2年死亡风险相似（调整后的风险比，1.15 [95%置信区间，0.90 - 1.47]，P = 0.26），但急性排斥反应的可能性较低（10.2%对16.1%，P = 0.04）。双供体与仅肺供体的受者出院前急性排斥反应的可能性相似（7.6%对8.5%，P = 0.70），72小时插管的可能性相似（38.9%对45.1%，P = 0.13），72小时体外膜肺氧合的可能性相似（13.1%对18.1%，P = 0.11），以及2年死亡风险相似（调整后的风险比，1.16 [95%置信区间，0.74 - 1.82]，P = 0.52）。
从循环死亡供体获取心脏和肺不会对移植结局产生负面影响。随着更多数据和更长时间的随访可得，该人群的结局应继续进行研究。
