Muston Benjamin T, Lo Winky, Eranki Aditya, Boffini Massimo, Loforte Antonio
The Collaborative Research Group (CORE), Sydney, Australia.
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Ann Cardiothorac Surg. 2025 Jan 26;14(1):1-10. doi: 10.21037/acs-2024-dcd-20. Epub 2025 Jan 9.
Controlled donation after circulatory death (cDCD) allografts made up a small fraction of donor hearts available for transplant, however it is estimated this could increase to 30% in future years. The purpose of this systematic review and meta-analysis was to describe the largest and most up-to-date short- and long-term survival outcomes for cDCD cardiac transplantation.
Three electronic databases were selected to complete the initial literature search from inception of records until February 2024. Primary outcomes were short-term survival at 12 months, as well as long-term time-to-event survival data. These data were calculated using aggregated Kaplan-Meier curves according to established methods. The secondary outcomes were acute rejection and primary graft dysfunction.
Following the PRISMA screening protocol, ten studies were included for analysis, eight of which were published in the last 12 months. A pooled cohort of 1,219 donor/recipient pairs were analyzed, of which all had graphical extraction of individual patient data to reveal an aggregated Kaplan-Meier curve. The survival estimates at 1, 3 and 5 years for the pooled cDCD cohort were 92.4%, 85.3% and 85.3%, respectively. In-hospital mortality rates were low at just 2.5%.
While only making up a small percentage of current heart transplant figures, cDCD allografts may not only significantly reduce waitlist times, but could also increase the donor pool, and improve survivability over current procurement techniques. Ultimately, cDCD allografts show promise in offering an effective and favorable procurement source for cardiac transplantation worldwide.
心脏死亡后器官捐献（cDCD）的同种异体移植物在可用于移植的供体心脏中占比很小，但据估计，在未来几年这一比例可能会增至30%。本系统评价和荟萃分析的目的是描述cDCD心脏移植最大且最新的短期和长期生存结果。
选择三个电子数据库，完成从记录起始至2024年2月的初始文献检索。主要结局为12个月时的短期生存以及长期事件发生时间生存数据。这些数据根据既定方法使用汇总的Kaplan-Meier曲线进行计算。次要结局为急性排斥反应和原发性移植物功能障碍。
按照PRISMA筛选方案，纳入10项研究进行分析，其中8项是在过去12个月内发表的。对1219对供体/受体组成的汇总队列进行了分析，所有研究均对个体患者数据进行了图形提取，以呈现汇总的Kaplan-Meier曲线。汇总的cDCD队列在1年、3年和5年时的生存估计分别为92.4%、85.3%和85.3%。住院死亡率较低，仅为2.5%。
虽然cDCD同种异体移植物目前在心脏移植数字中仅占一小部分，但它不仅可能显著缩短等待名单时间，还可能增加供体库，并提高相对于当前获取技术的生存率。最终，cDCD同种异体移植物有望为全球心脏移植提供一种有效且有利的获取来源。
