Gouchoe Doug A, Satija Divyaam, Cui Ervin Y, Schroder Jacob N, Milano Carmelo A, Bishawi Muath, Alvarez Ammu V, Choi Kukbin, Henn Matthew C, Lampert Brent C, Mokadam Nahush A, Whitson Bryan A, Ganapathi Asvin M
Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; COPPER Lab, The Ohio State University, Columbus, Ohio.
Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Thorac Cardiovasc Surg. 2025 Jul;170(1):268-276.e12. doi: 10.1016/j.jtcvs.2024.12.001. Epub 2024 Dec 9.
Normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) allow for transplantation with donation after circulatory death (DCD) hearts. This study aimed to characterize the use of and variations in NRP and DPP for DCD transplants in the United States.
Heart transplants performed between December 1, 2019 and March 31, 2024, were identified from the United Network for Organ Sharing database. DPP and NRP procurement strategies were classified based on previously published methods. The groups were compared, and survival was assessed using Kaplan-Meier methods. Geographic and center variability was categorized using encrypted data.
There were 595 NRP transplants and 625 DPP transplants. Distance traveled and out-of-body time were significantly lower for the NRP group (P < .01 for both). There were no significant differences in postoperative dialysis, stroke, or 1-year survival between the 2 groups; however, the rate of postoperative pacemaker placement was higher with NRP (P < .05). From 2019 to 2024, 54 of 61 centers (88.5%) used NRP, 50 of 61 centers (82%) used DPP, and 43 of 61 centers (70.5%) used both procurement techniques, with NRP the more popular DCD procurement technique. Geographically, NRP was more prevalent in regions 2, 5, and 8 used, whereas DPP was most prevalent in regions 1, 3, and 10.
The use of NRP is increasing in the United States, with tremendous growth seen since its introduction several years ago. Significant variation remains in the use of NRP and DPP, and further exploration of the impact of each procurement and preservation strategy on transplantation outcomes is needed.
常温区域灌注（NRP）和直接获取与灌注（DPP）可实现心脏循环死亡（DCD）供心的移植。本研究旨在描述美国DCD心脏移植中NRP和DPP的使用情况及差异。
从器官共享联合网络数据库中识别出2019年12月1日至2024年3月31日期间进行的心脏移植。DPP和NRP获取策略根据先前发表的方法进行分类。对两组进行比较，并使用Kaplan-Meier方法评估生存率。地理和中心变异性使用加密数据进行分类。
有595例NRP移植和625例DPP移植。NRP组的运输距离和体外时间显著更短（两者P均<0.01）。两组术后透析、中风或1年生存率无显著差异；然而，NRP术后起搏器植入率更高（P<0.05）。从2019年到2024年，61个中心中有54个（88.5%）使用NRP，61个中心中有50个（82%）使用DPP，61个中心中有43个（70.5%）使用两种获取技术，NRP是更常用的DCD获取技术。在地理上，NRP在使用的第2、5和8区域更为普遍，而DPP在第1、3和10区域最为普遍。
在美国，NRP的使用正在增加，自几年前引入以来有显著增长。NRP和DPP的使用仍存在显著差异，需要进一步探索每种获取和保存策略对移植结果的影响。
