Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
Albert Einstein College of Medicine, Bronx, New York, USA.
Clin Transplant. 2024 Aug;38(8):e15423. doi: 10.1111/ctr.15423.
Donation after circulatory death (DCD) donors are becoming an important source of organs for heart-transplantation (HT), but there are limited data regarding their use in multiorgan-HT.
Between January 2020 and June 2023, we identified 87 adult multiorgan-HTs performed using DCD-donors [77 heart-kidney, 6 heart-lung, 4 heart-liver] and 1494 multiorgan-HTs using donation after brain death (DBD) donors (1141 heart-kidney, 165 heart-lung, 188 heart-liver) in UNOS. For heart-kidney transplantations (the most common multiorgan-HT combination from DCD-donors), we also compared donor/recipient characteristics, and early outcomes, including 6-month mortality using Kaplan-Meier (KM) and Cox hazards-ratio (Cox-HR).
Use of DCD-donors for multiorgan-HTs in the United States increased from 1% in January to June 2020 to 12% in January-June 2023 (p < 0.001); but there was a wide variation across UNOS regions and center volumes. Compared to recipients of DBD heart-kidney transplantations, recipients of DCD heart-kidney transplantations were less likely to be of UNOS Status 1/2 at transplant (35.06% vs. 69.59%) and had lower inotrope use (22.08% vs. 43.30%), lower IABP use (2.60% vs. 26.29%), but higher durable CF-LVAD use (19.48% vs. 12.97%), all p < 0.01. Compared to DBD-donors, DCD-donors used for heart-kidney transplantations were younger [28(22-34) vs. 32(25-39) years, p = 0.004]. Recipients of heart-kidney transplantations from DCD-donors and DBD-donors had similar 6-month survival using both KM analysis, and unadjusted and adjusted Cox-HR models, including in propensity matched cohorts. Rates of PGF and in-hospital outcomes were also similar.
Use of DCD-donors for multiorgan-HTs has increased rapidly in the United States and early outcomes of DCD heart-kidney transplantations are promising.
心脏移植（HT）中，循环死亡后捐献（DCD）供体正在成为器官的重要来源，但关于其在多器官-HT 中的应用的数据有限。
2020 年 1 月至 2023 年 6 月，我们在 UNOS 中确定了 87 例使用 DCD 供体进行的成人多器官-HT（77 例心脏-肾脏，6 例心脏-肺，4 例心脏-肝脏）和 1494 例使用脑死亡后捐献（DBD）供体进行的多器官-HT（1141 例心脏-肾脏，165 例心脏-肺，188 例心脏-肝脏）。对于心脏-肾脏移植（最常见的 DCD 供体多器官-HT 组合），我们还比较了供体/受体特征以及包括使用 Kaplan-Meier（KM）和 Cox 风险比（Cox-HR）在内的 6 个月死亡率在内的早期结果。
在美国，多器官-HT 中使用 DCD 供体的比例从 2020 年 1 月至 6 月的 1%增加到 2023 年 1 月至 6 月的 12%（p<0.001）；但 UNOS 区域和中心容量存在很大差异。与 DBD 心脏-肾脏移植的受体相比，DCD 心脏-肾脏移植的受体在移植时更不可能是 UNOS 状态 1/2（35.06%对 69.59%），并且使用更少的正性肌力药（22.08%对 43.30%），更少使用 IABP（2.60%对 26.29%），但更高比例的耐用型 CF-LVAD（19.48%对 12.97%），所有这些差异均有统计学意义（p<0.01）。与 DBD 供体相比，用于心脏-肾脏移植的 DCD 供体更年轻[28（22-34）对 32（25-39）岁，p=0.004]。KM 分析、未调整和调整后的 Cox-HR 模型，包括倾向匹配队列，均显示 DCD 供体和 DBD 供体心脏-肾脏移植受体 6 个月的生存率相似。PGF 发生率和住院期间结局也相似。
美国多器官-HT 中使用 DCD 供体的比例迅速增加，DCD 心脏-肾脏移植的早期结果有希望。
