Cho Peter D, Kim Samuel T, Zappacosta Hedwig, White John P, McKay Stephanie, Biniwale Reshma, Ardehali Abbas
Drexel University College of Medicine, Philadelphia, PA, USA.
David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, CA, USA.
J Heart Lung Transplant. 2025 May;44(5):760-769. doi: 10.1016/j.healun.2024.11.027. Epub 2024 Nov 28.
This study compares the incidence of severe Primary Graft Dysfunction (PGD) in a contemporaneous cohort of donors after circulatory death (DCD) and brain death (DBD) heart transplant recipients.
The United Network for Organ Sharing database was queried for isolated adult heart transplant recipients from 9/2023 to 6/2024. Heart recipients were stratified based on the organ donation type (DCD vs DBD). DCD heart recipients were further categorized based on the procurement method: time between circulatory death to cross-clamp: ≤ 30 minutes (Direct Procurement and Preservation, DPP), >30 minutes (Normothermic Regional Perfusion, NRP). Outcomes of interest included: severe PGD (Left/Bi-Ventricular; LV/BiV) at 24 hours and Severe Graft Dysfunction at 72 hours (patients with severe PGD at 24 hours that remain on mechanical support at 72 hours).
A total of 2590 adult heart transplant recipients were identified, of which 17.1% underwent DCD heart transplantation. DCD heart recipients were less likely to be on inotrope (36.7% vs 41.6%, p=0.046) and ECMO (4.1% vs 9.9%, p<0.001) prior to transplant than DBD heart recipients. DCD heart recipients were more likely than DBD heart recipients to develop severe PGD (LV/BiV) at 24 hours (9.5% vs 5.1%, p<0.001). The Severe Graft Dysfunction at 72 hours (2.3% vs 2.9%, p=0.67) and 30-day mortality were similar between the 2 groups. Recipients of DCD heart procured with DPP or NRP had similar severe PGD (LV/BiV) at 24 hours (9.4% vs 9.7%, p=0.93).
Severe PGD at 24 hours is higher among the DCD than DBD heart recipients, but Graft Dysfunction improves by 72 hours.
本研究比较了同期循环死亡供者（DCD）和脑死亡供者（DBD）心脏移植受者中严重原发性移植物功能障碍（PGD）的发生率。
查询器官共享联合网络数据库，获取2023年9月至2024年6月期间孤立的成人心脏移植受者。心脏受者根据器官捐赠类型（DCD与DBD）进行分层。DCD心脏受者根据获取方法进一步分类：循环死亡至夹闭的时间：≤30分钟（直接获取与保存，DPP），>30分钟（常温区域灌注，NRP）。感兴趣的结局包括：24小时时的严重PGD（左/双心室；LV/BiV）和72小时时的严重移植物功能障碍（24小时时患有严重PGD且72小时时仍接受机械支持的患者）。
共确定了2590例成人心脏移植受者，其中17.1%接受了DCD心脏移植。与DBD心脏受者相比，DCD心脏受者在移植前使用血管活性药物的可能性较小（36.7%对41.6%，p=0.046），使用体外膜肺氧合（ECMO）的可能性较小（4.1%对9.9%，p<0.001）。DCD心脏受者在24小时时比DBD心脏受者更易发生严重PGD（LV/BiV）（9.5%对5.1%，p<0.001）。两组之间72小时时的严重移植物功能障碍（2.3%对2.9%，p=0.67）和30天死亡率相似。采用DPP或NRP获取的DCD心脏受者在24小时时的严重PGD（LV/BiV）相似（9.4%对9.7%，p=0.93）。
DCD心脏受者中24小时时严重PGD的发生率高于DBD心脏受者，但移植物功能障碍在72小时时有所改善。
