Groba Marco Maria Del Val, Cabrera Santana Miriam, Galvan Ruiz Mario, Fernandez de Sanmamed Miguel, Romero Lujan Jose Luis, Gonzalez Martin Jesus Maria, Santana Ortega Luis, Espinar María Vazquez, Portela Torron Francisco, Peña Morant Vicente, Caballero Dorta Eduardo Jose, Garcia Quintana Antonio
Cardiology Department, Hospital Universitario de Gran Canaria Dr. Negrin, 35019 Las Palmas de Gran Canaria, Spain.
Departamento de Ciencias Medicas y Quirurgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain.
J Clin Med. 2024 Aug 23;13(17):4972. doi: 10.3390/jcm13174972.
(1) Cardiac donation after circulatory death (DCD) is an emerging paradigm in organ transplantation. However, this technique is recent and has only been implemented by highly experienced centers. This study compares the characteristics and outcomes of thoraco-abdominal normothermic regional perfusion (TANRP) and static cold-storage DCD and traditional donation after brain death (DBD) cardiac transplants (CT) in a newly stablished transplant program with restricted donor availability. (2) We performed a retrospective, single-center study of all adult patients who underwent a CT between November 2019 and December 2023, with a follow-up conducted until August 2024. Data were retrieved from medical records. A review of the current literature on DCD CT was conducted to provide a broader context for our findings. The primary outcome was survival at 6 months after transplantation. (3) During the study period, 76 adults (median age 56 years [IQR: 50-63 years]) underwent CT, and 12 (16%) were DCD donors. DCD donors had a similar age (46 vs. 47 years, = 0.727), were mostly male (92%), and one patient had left ventricular dysfunction during the intraoperative DCD process. There were no significant differences in recipients' characteristics. Survival was similar in the DCD group compared to DBD at 6 months (100 vs. 94%) and 12 months post-CT survival (92% vs. 94%), = 0.82. There was no primary graft dysfunction in the DCD group (9% in DBD, = 0.581). The median total hospital stay was longer in the DCD group (46 vs. 21 days, = 0.021). An increase of 150% in transplantation activity due to DCD was estimated. (4) In a new CT program that utilized older donors and included recipients with similar illnesses and comorbidities, comparable outcomes between DCD and DBD hearts were observed. DCD was rapidly incorporated into the transplant activity, demonstrating an expedited learning curve and significantly increasing the availability of donor hearts.
(1) 心脏死亡后器官捐献（DCD）是器官移植领域中一种新兴的模式。然而，这项技术尚新，仅在经验丰富的中心得以实施。本研究比较了在一个供体来源受限的新建移植项目中，胸腹常温区域灌注（TANRP）和静态冷藏DCD以及传统脑死亡后器官捐献（DBD）心脏移植（CT）的特点和结果。(2) 我们对2019年11月至2023年12月期间接受心脏移植的所有成年患者进行了一项回顾性单中心研究，并随访至2024年8月。数据从病历中获取。对当前关于DCD心脏移植的文献进行了综述，以便为我们的研究结果提供更广泛的背景。主要结局是移植后6个月的生存率。(3) 在研究期间，76名成年人（中位年龄56岁[四分位间距：50 - 63岁]）接受了心脏移植，其中12名（16%）为DCD供体。DCD供体年龄相似（46岁对47岁，P = 0.727），大多为男性（92%），且有1例患者在术中DCD过程中出现左心室功能障碍。受者特征方面无显著差异。DCD组与DBD组在移植后6个月的生存率相似（100%对94%），心脏移植后12个月的生存率也相似（92%对94%），P = 0.82。DCD组未出现原发性移植物功能障碍（DBD组为9%，P = 0.581）。DCD组的中位总住院时间更长（46天对21天，P = 0.021）。据估计，由于DCD，移植活动增加了150%。(4) 在一个使用老年供体且纳入患有相似疾病和合并症受者的新心脏移植项目中，观察到DCD心脏与DBD心脏的结局相当。DCD迅速融入移植活动，显示出快速的学习曲线，并显著增加了供体心脏的可获得性。
