使用循环性死亡后供体进行心脏移植的早期结果，这些供体用于接受耐用左心室辅助装置过渡的患者。
Early outcomes in heart transplantation using donation after circulatory death donors in patients bridged with durable left ventricular assist devices.
作者信息
Moroi Morgan K, Patel Krushang, Rajesh Kavya, Lin Allison, Wang Pengchen, Wang Chunhui, Zhao Yanling, Kurlansky Paul A, Latif Farhana, Sayer Gabriel T, Uriel Nir, Naka Yoshifumi, Takeda Koji
机构信息
Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY.
Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY.
出版信息
J Thorac Cardiovasc Surg. 2025 May;169(5):1499-1508.e13. doi: 10.1016/j.jtcvs.2024.08.050. Epub 2024 Sep 12.
OBJECTIVE
Donation after circulatory death heart transplantation potentially increases donor allografts, especially for patients with lower listing status. We assessed the outcomes of donation after circulatory death heart transplantation in patients bridged with durable left ventricular assist devices.
METHODS
The United Network for Organ Sharing database was queried for adult heart transplants using donation after circulatory death donors from 2019 to 2022. Patients were stratified between those with durable left ventricular assist devices and those with intra-aortic balloon pump, inotropic, or no bridging support (control group). Primary outcome was 1-year mortality. Secondary end points were hospital length of stay, stroke, pacemaker implantation, dialysis, and acute rejection before discharge.
RESULTS
A total of 160 left ventricular assist device recipients and 311 control recipients met study inclusion criteria. Recipients bridged with left ventricular assist devices were younger (55 vs 58 years, P < .001) with lower body mass index (28.3 vs 30.3, P < .001), longer waitlist times (112 vs 34 days, P < .001), longer out of body times (5.7 vs 4.6 hours, P < .001), and less frequent normothermic regional perfusion (31% vs 40%, P = .049). Patients with left ventricular assist devices commonly underwent transplantation at United Network for Organ Sharing status 3 and 4 (92%), whereas control patients underwent transplantation at status 2 (27%), status 3 (10%), status 4 (30%), or status 6 (30%). Kaplan-Meier analysis showed no difference in 1-year mortality between groups (P = .34). However, acute rejection was higher in the unadjusted left ventricular assist device cohort (26% vs 13%, P < .001). On multivariable logistic regression, left ventricular assist device was an independent predictor of acute rejection (odds ratio, 2.21, 95% CI, 1.32-3.69, P = .002).
CONCLUSIONS
Durable left ventricular assist devices may be associated with a higher risk of developing an early inflammatory response in donation after circulatory death heart transplantation; however, 1-year survival was similar between groups.
目的
心脏停搏后器官捐献心脏移植有可能增加供体移植物，特别是对于排队状态较低的患者。我们评估了使用耐用左心室辅助装置过渡的患者心脏停搏后器官捐献心脏移植的结果。
方法
查询器官共享联合网络数据库中2019年至2022年使用心脏停搏后器官捐献供体的成人心脏移植情况。患者被分为使用耐用左心室辅助装置的患者和使用主动脉内球囊泵、血管活性药物或无过渡支持的患者（对照组）。主要结局是1年死亡率。次要终点包括住院时间、中风、起搏器植入、透析以及出院前的急性排斥反应。
结果
共有160例左心室辅助装置受者和311例对照受者符合研究纳入标准。使用左心室辅助装置过渡的受者更年轻（55岁对58岁，P<0.001），体重指数更低（28.3对30.3，P<0.001），等待名单时间更长（112天对34天，P<0.001），体外时间更长（5.7小时对4.6小时，P<0.001），常温区域灌注频率更低（31%对40%，P=0.049）。使用左心室辅助装置的患者通常在器官共享联合网络状态3和4时接受移植（92%），而对照患者在状态2（27%）、状态3（10%）、状态4（30%）或状态6（30%）时接受移植。Kaplan-Meier分析显示两组之间1年死亡率无差异（P=0.34）。然而，未经调整的左心室辅助装置队列中急性排斥反应更高（26%对13%，P<0.001）。在多变量逻辑回归分析中，左心室辅助装置是急性排斥反应的独立预测因素（比值比，2.21，95%CI，1.32-3.69，P=0.002）。
结论
在心脏停搏后器官捐献心脏移植中，耐用左心室辅助装置可能与早期炎症反应风险较高有关；然而，两组之间1年生存率相似。
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