Department of Medicine Massachusetts General Hospital Boston MA USA.
Nephrology Division Massachusetts General Hospital Boston MA USA.
J Am Heart Assoc. 2024 Oct 15;13(20):e035443. doi: 10.1161/JAHA.124.035443. Epub 2024 Oct 8.
Transplantation using hearts obtained through donation after circulatory death (DCD) is increasing, but data on recipient renal outcomes are limited.
Patients at a single institution who underwent heart transplantation using organs procured through DCD or donation after brain death (DBD) from April 2016 to August 2022 were included in this retrospective cohort study. Hemodynamic measures were collected via right heart catheterization performed 1 week after transplantation. Posttransplantation renal outcomes included estimated glomerular filtration rate at 1 week, 4 weeks, and 16 weeks, and the incidence of acute kidney injury (AKI) and renal replacement therapy within 1 week. The analysis included 225 patients (55 recipients of DCD). Baseline characteristics were comparable between recipients of DCD and DBD. Renal outcomes within 1 week posttransplantation in recipients of DCD were similar to recipients of DBD, including percent change in estimated glomerular filtration rate (-37.9% [-58.6 to -6.2] versus -31.9% [-52.4 to -9.9]; =0.91), incidence of AKI (47.3% versus 46.5%; >0.99) and incidence of renal replacement therapy (3.6% versus 4.7%; >0.99). Recipients of DCD with AKI within 1 week ("early AKI") did not recover to baseline estimated glomerular filtration rate (75.8 [60.2-91.3] mL/min per 1.73 m) by week 16 (59.3 [46.9-73.6] mL/min per 1.73 m; =0.002), whereas recipients without early AKI exhibited comparable estimated glomerular filtration rate to baseline by week 4 (84.5 [70.8-98.5] mL/min per 1.73 m; =0.084). Similar trends were observed in recipients of DBD.
Recipients of DCD demonstrated similar renal outcomes compared with recipients of DBD, supporting the ongoing use of DCD transplantation. Early AKI was associated with persistent renal dysfunction for recipients of both DCD and DBD.
使用通过心跳停止后捐献（DCD）获得的供心进行移植的情况正在增加，但有关受体肾脏结局的数据有限。
本回顾性队列研究纳入了 2016 年 4 月至 2022 年 8 月期间，在一家机构接受通过 DCD 或脑死亡后捐献（DBD）获取的器官进行心脏移植的患者。在移植后 1 周通过右心导管术采集血流动力学测量值。移植后 1 周、4 周和 16 周的估算肾小球滤过率以及 1 周内急性肾损伤（AKI）和肾脏替代治疗的发生率被用作移植后肾脏结局的评估指标。该分析共纳入 225 例患者（55 例接受 DCD）。DCD 组和 DBD 组患者的基线特征相似。DCD 组患者在移植后 1 周内的肾脏结局与 DBD 组患者相似，包括估算肾小球滤过率的变化百分比（-37.9%[-58.6 至-6.2]比-31.9%[-52.4 至-9.9]；=0.91）、AKI 发生率（47.3%比 46.5%；>0.99）和肾脏替代治疗的发生率（3.6%比 4.7%；>0.99）。DCD 组中在移植后 1 周内发生 AKI 的患者（“早期 AKI”）在 16 周时未恢复至基线估算肾小球滤过率（75.8[60.2-91.3]mL/min/1.73m）（59.3[46.9-73.6]mL/min/1.73m；=0.002），而没有早期 AKI 的患者在 4 周时其估算肾小球滤过率与基线相似（84.5[70.8-98.5]mL/min/1.73m；=0.084）。DBD 组患者也观察到类似的趋势。
与 DBD 组受体相比，DCD 组受体的肾脏结局相似，支持继续使用 DCD 移植。早期 AKI 与 DCD 和 DBD 组受体的持续性肾功能障碍相关。
