Chang Stephanie H, Geraci Travis C, Piper Greta L, Chan Justin, James Les, Paone Darien, Sommer Philip M, Natalini Jake, Rudym Darya, Lesko Melissa, Hussain Syed T, Reyentovich Alex, Moazami Nader, Smith Deane E, Angel Luis
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
Department of Cardiothoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, New York.
JHLT Open. 2024 Feb 1;4:100058. doi: 10.1016/j.jhlto.2024.100058. eCollection 2024 May.
Donation after circulatory death with thoracoabdominal normothermic regional perfusion (DCD-NRP) for cardiac transplant has promising results, though data for lung transplant is lacking. This study evaluates lung transplant outcomes using DCD-NRP allografts.
All patients who underwent lung transplantation (LT) from June 1, 2020, to July 5, 2023, at a single institution were evaluated. Recipients received organs from DCD-NRP or brain dead (control) donors (donation after brain death (DBD)). All DCD-NRP were adult, primary bilateral LT (BLT) without preoperative extracorporeal membrane oxygenation (ECMO). Inclusion criteria for controls were age >18 years, BLT, no preoperative ECMO, and primary transplantation. Comparison was separated by LT or heart-lung transplant (HLT). The primary outcome was primary graft dysfunction (PGD) grade 3 at 72 hours.
There were 8 LT and 3 HLT in the DCD-NRP cohort, and 138 BLT and 7 HL DBD controls. PGD grade 3 at 72 hours was 0% in the entire DCD-NRP cohort (vs control: 9.4% LT and 0% HLT). There were no statistically significant differences in donor and recipient characteristics, though DCD-NRP HLT had significantly shorter ischemic time (85 vs 200 minutes, < 0.02). Thirty-day and 90-day mortality and 1-year survival are similar in both cohorts for LT and HLT. To date, DCD-NRP recipients are all on room air, with 0% acute cellular rejection rate and 91% (10/11) without chronic rejection. The lung utilization rate of evaluated DCD-NRP donors was 100%.
Initial results of LT using DCD-NRP organs demonstrate similar PGD grade 3 at 72 hours and similar survival to standard donors.
采用胸腹常温区域灌注的心脏移植循环死亡后捐赠（DCD-NRP）取得了有前景的结果，不过肺移植的数据尚缺。本研究评估使用DCD-NRP同种异体移植物的肺移植结局。
对2020年6月1日至2023年7月5日在单一机构接受肺移植（LT）的所有患者进行评估。接受者接受来自DCD-NRP或脑死亡（对照）供体（脑死亡后捐赠（DBD））的器官。所有DCD-NRP均为成人，进行初次双侧肺移植（BLT），术前未使用体外膜肺氧合（ECMO）。对照的纳入标准为年龄>18岁、BLT、无术前ECMO且为初次移植。比较按LT或心肺移植（HLT）分开。主要结局为72小时时的3级原发性移植物功能障碍（PGD）。
DCD-NRP队列中有8例LT和3例HLT，以及138例BLT和7例HL DBD对照。整个DCD-NRP队列中72小时时3级PGD为0%（对照：LT为9.4%，HLT为0%）。供体和接受者特征无统计学显著差异，不过DCD-NRP HLT的缺血时间显著更短（85分钟对200分钟，<0.02）。LT和HLT的两个队列在30天和90天死亡率及1年生存率方面相似。迄今为止，DCD-NRP接受者均呼吸室内空气，急性细胞排斥率为0%，91%（10/11）无慢性排斥。评估的DCD-NRP供体的肺利用率为100%。
使用DCD-NRP器官进行LT 的初步结果显示，72小时时3级PGD与标准供体相似，生存率也相似。
