Stehlik Josef, Farr Maryjane A, Mehra Mandeep R, Schroder Jacob N, D'Alessandro David A, Pal Jay D, Villavicencio Mauricio A, Gruber Peter J, Couper Gregory S, Shudo Yasuhiro, Patel Parag C, Daneshmand Mani A, Klein Liviu, Shah Ashish S, Skipper Eric R, Esmailian Fardad, Goldstein Daniel, Ohira Suguru, Lozonschi Lucian, Kaczorowski David J, Takeda Koji, Malyala Rajasekhar S R, Haft Jonathan W, Meyer Dan M, Sun Benjamin C, Pretorius Victor, Kilic Arman, Anyanwu Anelechi C, Williams Celeste T, Pham Duc T, Kai Masashi, Sulemanjee Nasir Z, Itoh Akinobu, Funamoto Masaki, Salerno Christopher T, Ikonomidis John S, Durham Lucian A, Shaffer Andrew, Zhou Xiang, Zafar Farhan, Pinney Sean P, Milano Carmelo A
University of Utah, Salt Lake City (J.S.).
UT Southwestern Medical Center, Dallas, TX (M.A.F.).
Circulation. 2025 Apr;151(13):896-909. doi: 10.1161/CIRCULATIONAHA.124.071743. Epub 2025 Mar 7.
A preservation system, the Organ Care System (OCS; TransMedics) uses normothermic pulsatile perfusion during organ transport for heart transplantation. This system has demonstrated favorable outcomes in hearts recovered from extended-criteria donors after brain death (DBD) and donors after circulatory death (DCD).
The OCS Heart Perfusion Registry collects data on US heart transplantations using the OCS, static cold storage (SCS), or thoracoabdominal normothermic regional perfusion (NRP) and donor hearts recovered from DBD or DCD donors. We analyzed donor and recipient characteristics and posttransplantation outcomes in patients transplanted with OCS donor hearts (either DBD or DCD) compared with SCS hearts, and with OCS hearts from DCD donors compared with those recovered with NRP followed by SCS. Propensity score matching was used in survival analyses to adjust for differences among recipient characteristics.
Between 2021 and 2023, 3225 consecutive heart transplantations enrolled from 56 centers were analyzed in the Heart Perfusion Registry. The OCS was used in 854 of 3225 heart transplantations (26.4%), among which 340 (39.8%) were DBD and 514 (60.2%) were DCD donors, whereas 2174 DBD donors were recovered with SCS and another 197 DCD donors with NRP techniques. The OCS-DBD group experienced a greater number of organ offer refusals before final acceptance (13 versus 6; Wilcoxon rank sum, <0.001) and a longer transport distance (667 miles versus 232 miles; Wilcoxon rank sum, <0.001) compared with SCS-DBD. Survival at 12 months was similar between the 2 groups (89.9% for OCS-DBD versus 90.6% for SCS-DBD; marginal Cox model, =0.54). Among the OCS-DCD and SCS-DBD groups, survival at 12 months was also similar (91.0% versus 92.5%, respectively; marginal Cox model, =0.32). The OCS-DCD and NRP-DCD groups demonstrated similar survival (91.0% versus 91.7%, respectively; log rank, =0.63), although the transport distance was longer in OCS-DCD compared with DCD with NRP followed by SCS (400 miles versus 223 miles; Wilcoxon rank sum, <0.001). By 2023, 90% of all OCS donor management and recovery was performed with dedicated organ recovery teams.
We demonstrate that real-world implementation of the OCS for DBD donors (using predominantly a dedicated recovery team) is associated with expanded donor criteria, longer transport distance, and excellent posttransplantation outcomes. In OCS-DCD donors, outcomes parallel those of donors recovered with NRP-DCD and compare favorably with DBD donor organs.
一种器官保存系统——器官护理系统（OCS；TransMedics公司），在心脏移植的器官运输过程中采用常温搏动灌注。该系统已在脑死亡（DBD）后扩大标准供体以及循环死亡后供体（DCD）获取的心脏中显示出良好效果。
OCS心脏灌注登记处收集美国使用OCS、静态冷藏（SCS）或胸腹常温区域灌注（NRP）进行心脏移植的数据，以及从DBD或DCD供体获取的供心数据。我们分析了接受OCS供心（DBD或DCD）移植的患者与接受SCS供心移植的患者的供体和受体特征及移植后结局，以及接受DCD供体的OCS供心移植的患者与接受NRP后接SCS获取的供心移植的患者的供体和受体特征及移植后结局。生存分析中使用倾向评分匹配来调整受体特征的差异。
在2021年至2023年期间，心脏灌注登记处分析了来自56个中心的3225例连续心脏移植病例。3225例心脏移植中有854例（26.4%）使用了OCS，其中340例（39.8%）供体为DBD，514例（60.2%）供体为DCD，而2174例DBD供体通过SCS获取，另有197例DCD供体通过NRP技术获取。与SCS - DBD相比，OCS - DBD组在最终接受前器官被拒绝的次数更多（13次对6次；Wilcoxon秩和检验，P<0.001），运输距离更长（667英里对232英里；Wilcoxon秩和检验，P<0.001）。两组12个月时的生存率相似（OCS - DBD组为89.9%，SCS - DBD组为90.6%；边际Cox模型，P = 0.54）。在OCS - DCD和SCS - DBD组中，12个月时的生存率也相似（分别为91.0%对92.5%；边际Cox模型，P = 0.32）。OCS - DCD组和NRP - DCD组的生存率相似（分别为91.0%对91.7%；对数秩检验，P = 0.63），尽管与NRP后接SCS的DCD组相比，OCS - DCD组的运输距离更长（400英里对223英里；Wilcoxon秩和检验，P<0.001）。到2023年，所有OCS供体管理和获取工作的90%由专门的器官获取团队完成。
我们证明，在现实世界中对DBD供体实施OCS（主要使用专门的获取团队）与扩大供体标准、更长的运输距离以及出色的移植后结局相关。在OCS - DCD供体中，结局与通过NRP - DCD获取的供体相当，且与DBD供体器官相比具有优势。
