Boffini Massimo, Gerosa Gino, Luciani Giovanni Battista, Pacini Davide, Russo Claudio Francesco, Rinaldi Mauro, Terzi Amedeo, Pelenghi Stefano, Luzi Giampaolo, Zanatta Paolo, Zanierato Marinella, Sacchi Marco, Bottazzi Andrea, Tarzia Vincenzo, Onorati Francesco, Pellegrini Carlo, Suarez Sofia Martin, Mondino Michele, Lilla Della Monica Paola, Nanni Andrea, Marro Matteo, Oliveti Alessandra, Feltrin Giuseppe, Cardillo Massimo
Cardiac Surgery Division, Surgical Sciences Department, Città della Salute e della Scienza, University of Turin, Turin, Italy.
Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy.
Ann Cardiothorac Surg. 2025 Jan 26;14(1):47-54. doi: 10.21037/acs-2024-dcd-27. Epub 2025 Jan 17.
Donation after circulatory death (DCD) donation is becoming more and more popular worldwide. However, in this setting of donation, heart graft suffers from the ischemic injury related with the cardiac arrest. In Italy, the declaration of death with cardiac parameters requires the registration of electrocardiograph for twenty minutes resulting in a very prolonged grafts' warm ischemia time. The aim of this study is to present the Italian preliminary experience on heart transplantation (HTx) from controlled DCD (cDCD) donors.
Despite a very long period of warm ischemic time (WIT) expected, in April 2023, a DCD heart program was started in Italy and in May 2023 the first DCD heart transplant was performed. In the present paper, preliminary results of the national program are analyzed.
Since May 2023 until December 2024, 40 DCD heart transplants were performed in Italy. Donors' characteristics were the followings: 31 male, nine female, mean age of 46.6±14.7 years. Causes of death were: 19 trauma, eight cerebral bleeding, four post-anoxia coma, nine others. Three donors showed mild coronary artery disease at angiography. Mean WIT was 43.2±10.8 minutes. Thoraco-abdominal normothermic regional perfusion (T-A NRP) was used in all cases. Recipients' characteristics were the followings: 33 males, seven females, mean age 59.1±12.3 years, 16 re-operations (REDO), 18 on an urgent list. Eight (21%) patients required post-transplant extracorporeal membrane oxygenation (ECMO), four (50%) of whom were successfully weaned. Thirty-day mortality was 10%. Median duration of post-transplant mechanical ventilation, intensive care unit stay and hospital stay was 45 hours, six days and 28 days respectively. At discharge, mean ejection fraction (EF) was 57.8%±10% and tricuspid annular plane systolic excursion (TAPSE) 18.2±3.1 mm, without any significant valvular disfunction.
Italian preliminary results suggest that DCD heart transplantation can be successful despite a very long WIT and marginal donors' characteristics. A larger experience and data about medium and long-term results are mandatory to better confirm the short-term findings.
心脏死亡后器官捐献（DCD）在全球范围内越来越普遍。然而，在这种捐献情况下，心脏移植物会遭受与心脏骤停相关的缺血性损伤。在意大利，根据心脏参数判定死亡需要记录20分钟的心电图，这导致移植物的热缺血时间非常长。本研究的目的是介绍意大利在可控心脏死亡后器官捐献（cDCD）供体心脏移植（HTx）方面的初步经验。
尽管预计热缺血时间（WIT）很长，但2023年4月意大利启动了DCD心脏项目，并于2023年5月进行了首例DCD心脏移植。在本文中，对该国家项目的初步结果进行了分析。
自2023年5月至2024年12月，意大利共进行了40例DCD心脏移植。供体特征如下：男性31例，女性9例，平均年龄46.6±14.7岁。死亡原因包括：19例创伤，8例脑出血，4例缺氧后昏迷，9例其他原因。3例供体在血管造影时显示轻度冠状动脉疾病。平均WIT为43.2±10.8分钟。所有病例均采用胸腹常温区域灌注（T-A NRP）。受体特征如下：男性33例，女性7例，平均年龄59.1±12.3岁，16例再次手术（redo），18例在紧急名单上。8例（21%）患者术后需要体外膜肺氧合（ECMO），其中4例（50%）成功脱机。30天死亡率为10%。术后机械通气、重症监护病房停留时间和住院时间的中位数分别为45小时、6天和28天。出院时，平均射血分数（EF）为57.8%±10%，三尖瓣环平面收缩期位移（TAPSE）为18.2±3.1mm，无明显瓣膜功能障碍。
意大利的初步结果表明，尽管WIT很长且供体特征不佳，但DCD心脏移植仍可能成功。需要更多的经验和中长期结果数据来更好地证实这些短期发现。
