Christopher Kwon Ye In, Burmistrova Michelle, Zhu David T, Lai Alan, Park Andrew, Sharma Aadi, Nicolato Patricia, Fitch Zachary, Quader Mohammed, Chery Josue, Kasirajan Vigneshwar, Robich Michael P, Kilic Ahmet, Hashmi Zubair A
Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Va.
Albany Medical College, Albany, NY.
J Thorac Cardiovasc Surg. 2025 Aug;170(2):594-605.e2. doi: 10.1016/j.jtcvs.2024.12.016. Epub 2024 Dec 24.
In the setting of the obesity epidemic and donor organ shortage in the United States, there is a growing need to expand the donor organ eligibility criteria for orthotopic heart transplantation (OHT). Donation after circulatory death (DCD) has emerged as a promising solution, but the outcomes with obese donor hearts in DCD OHT remains unknown.
Using the United Network for Organ Sharing registry between 2019 and 2024, recipients of DCD OHT were stratified into 3 donor obesity categories by body mass index (BMI): underweight/normal (BMI <25 kg/m), overweight (BMI 25-30 kg/m), and obese (BMI >30 kg/m). These cohorts were subgrouped by organ procurement strategy: direct procurement and preservation (DPP) or normothermic regional perfusion (NRP). Recipient and donor characteristics and risk factors for mortality were analyzed using Cox regression hazard models. Survival at 30 days, 1 year, and 5 years post-transplantation were analyzed using the Kaplan-Meier method.
We found no significant differences in patient and graft survival between donor BMI categories at all time points. Among recipients of overweight (hazard ratio [HR], 0.38; P = .0371) and obese (HR, 0.24; P = .0493) donor hearts, NRP was associated with decreased risk of mortality. Donor-recipient predicted heart mass (PHM) undermatching (defined as <86%) was associated with increased risk of mortality among underweight/normal weight donors (HR, 1.28; P = .0323) and overweight donors (HR, 1.08; P = .0382).
Donor obesity does not confer an increased risk of recipient mortality in DCD OHT, particularly when NRP is used. PHM undermatching continues to be associated with adverse outcomes in DCD OHT.
在美国肥胖症流行且供体器官短缺的情况下，扩大原位心脏移植（OHT）的供体器官资格标准的需求日益增长。心脏死亡后捐献（DCD）已成为一种有前景的解决方案，但DCD OHT中肥胖供体心脏的移植结果仍不明确。
利用器官共享联合网络2019年至2024年的登记数据，将DCD OHT受者按体重指数（BMI）分为3个供体肥胖类别：体重过轻/正常（BMI<25kg/m²）、超重（BMI 25-30kg/m²）和肥胖（BMI>30kg/m²）。这些队列再按器官获取策略进行亚组划分：直接获取与保存（DPP）或常温区域灌注（NRP）。使用Cox回归风险模型分析受者和供体特征以及死亡风险因素。采用Kaplan-Meier方法分析移植后30天、1年和5年的生存率。
我们发现在所有时间点，供体BMI类别之间的患者和移植物生存率无显著差异。在超重（风险比[HR]，0.38；P = 0.0371）和肥胖（HR，0.24；P = 0.0493）供体心脏的受者中，NRP与死亡风险降低相关。供体-受者预测心脏质量（PHM）不匹配（定义为<86%）与体重过轻/正常体重供体（HR，1.28；P = 0.0323）和超重供体（HR，1.08；P = 0.0382）的死亡风险增加相关。
在DCD OHT中，供体肥胖不会增加受者死亡风险，尤其是在使用NRP时。PHM不匹配在DCD OHT中仍然与不良结局相关。
