Goodwin Matthew L, Nickel Ian C, Li Hui, Kagawa Hiroshi, Kyriakopoulos Christos P, Hanff Thomas C, Stehlik Josef, Drakos Stavros G, Selzman Craig H
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, Utah.
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, Utah.
J Thorac Cardiovasc Surg. 2024 Oct 26. doi: 10.1016/j.jtcvs.2024.10.033.
Donation after circulatory death (DCD) heart transplants have increased in the United States with direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of the DCD technique on post-transplant outcomes compared to donation after brain death (DBD) donors.
Adult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023, were identified in the United Network for Organ Sharing registry. DPP and TA-NRP groups were identified using time of death to an aortic cross-clamp time of 30 minutes. Categorical variables were compared using the χ or Fisher exact test, and continuous variables were compared using the Mann-Whitney U test. Propensity score matching was performed using a 1:3 match. One-year survival was analyzed using the log-rank test and a Cox proportional hazard regression model.
During the study period, there were 7338 DBD and 419 DCD heart transplants. At 1 year post-transplant, there was no difference in survival between unmatched (P = .13) and matched (P = .36) DBD and DCD heart recipients. There was an increase in acute rejection and rejection requiring treatment in DCD recipients compared to DBD recipients in the matched cohort. A total of 134 TA-NRP transplants and 242 DPP transplants were performed. One-year survival and post-transplant outcomes were similar in the DPP and TA-NRP groups. TA-NRP functional warm ischemia time (fWIT) was increased significantly during the study period.
In this matched cohort, DCD heart recipients experienced increased acute rejection, both treated and nontreated, compared to DBD heart recipients. Despite differences in the techniques and likely in fWIT, acute rejection, survival, and other secondary outcomes are similar with DPP and TA-NRP.
在美国，随着采用机器灌注直接获取（DPP）和胸腹常温区域灌注（TA-NRP）技术，心脏死亡后器官捐献（DCD）心脏移植数量有所增加。目前，关于DPP和TA-NRP结果的数据仍然很少。本研究的目的是探讨与脑死亡后器官捐献（DBD）供体相比，DCD技术对移植后结果的影响。
在器官共享联合网络登记处识别出2019年12月1日至2023年6月30日期间接受心脏移植的成年患者。根据死亡时间至主动脉阻断时间30分钟来确定DPP组和TA-NRP组。分类变量采用χ²检验或Fisher精确检验进行比较，连续变量采用Mann-Whitney U检验进行比较。采用1:3匹配进行倾向得分匹配。使用对数秩检验和Cox比例风险回归模型分析1年生存率。
在研究期间，有7338例DBD心脏移植和419例DCD心脏移植。移植后1年，未匹配（P = 0.13）和匹配（P = 0.36）的DBD和DCD心脏受者的生存率无差异。与匹配队列中的DBD受者相比，DCD受者的急性排斥反应和需要治疗的排斥反应有所增加。共进行了134例TA-NRP移植和242例DPP移植。DPP组和TA-NRP组的1年生存率和移植后结果相似。研究期间，TA-NRP的功能性热缺血时间（fWIT）显著增加。
在这个匹配队列中，与DBD心脏受者相比，DCD心脏受者的急性排斥反应无论是接受治疗还是未接受治疗的都有所增加。尽管技术不同且fWIT可能存在差异，但DPP和TA-NRP的急性排斥反应、生存率和其他次要结果相似。
