Ahmad Awab, Harris Timothy R, Williams Aaron, DeBose-Scarlett Alexandra, Kamal Rubayet, Adjei Enock Atta, Siddiqi Hasan K, Wang Chen Chia, Petrovic Mark, Keck Clifton D, Scholl Shelley R, Shah Ashish S, Bommareddi Swaroop, Lima Brian, Trahanas John M
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville TN.
Meharry Medical College School of Medicine, Nashville TN.
JHLT Open. 2025 Jan 22;7:100217. doi: 10.1016/j.jhlto.2025.100217. eCollection 2025 Feb.
Local surgeon recovery of donor livers and kidneys is common and well-studied. This practice is rare and poorly studied in cardiac transplantation. We examined clinical outcomes of cardiac allografts recovered by local surgeons vs. recipient institution surgeons.
A retrospective review of all recoveries of adult cardiac allografts from brain dead donors for a single academic transplant center between 1/2020 and 12/2021 was performed. Donor and recipient baseline characteristics, distance traveled and ischemic time, and recipient outcomes were collected. Primary graft dysfunction (PGD) was determined based on 2014 ISHLT guidelines.
218 recovery attempts were included, 25 conducted by local surgeons. Donor demographics between the two groups were similar, with a mean age of 31.5±10 years. There was a non-significant trend towards higher acceptance rates by local surgeons compared to recipient center surgeons (96% vs 82.9%, p=0.139). Ischemic times (208±28 vs 176±61 min p=0.003) and travel distances (788 vs 615 miles, p=0.011) were longer in the local recovery group. There was no difference in severe PGD (4.2% vs 7.5%, p=1.0), moderate/severe PGD (12.5% vs 14.4%, p=0.22) or 30-day survival (95.8% vs 95%, p=0.218) between the local surgeon and recipient center recovered allografts.
Cardiac allografts recovered by a local surgeon team are high quality with similar rates of organ acceptance, PGD, and 30-day survival. This provides evidence that leveraging the expertise of the local surgical team is a safe and effective method for decreasing travel risks, financial expenditure, and opportunity cost associated with cardiac allograft recovery.
当地外科医生对供肝和供肾的获取操作很常见且研究充分。而这种做法在心脏移植中很少见且研究不足。我们比较了由当地外科医生与受者机构外科医生获取心脏同种异体移植物的临床结果。
对 2020 年 1 月至 2021 年 12 月间，一家学术移植中心所有来自脑死亡供者的成人心脏同种异体移植物获取情况进行回顾性分析。收集供者和受者的基线特征、行程距离和缺血时间以及受者的结局。根据 2014 年国际心脏和肺移植学会（ISHLT）指南确定原发性移植物功能障碍（PGD）。
共纳入 218 次获取尝试，其中 25 次由当地外科医生进行。两组供者人口统计学特征相似，平均年龄为 31.5±10 岁。与受者中心外科医生相比，当地外科医生的接受率有升高趋势，但差异无统计学意义（96%对 82.9%，p = 0.139）。当地获取组的缺血时间（208±28 分钟对 176±61 分钟，p = 0.003）和行程距离（788 英里对 615 英里，p = 0.011）更长。当地外科医生获取的移植物与受者中心获取的移植物在严重 PGD（4.2%对 7.5%，p = 1.0）、中度/重度 PGD（12.5%对 14.4%，p = 0.22）或 30 天生存率（95.8%对 95%，p = 0.218）方面无差异。
由当地外科医生团队获取的心脏同种异体移植物质量高，在器官接受率、PGD 和 30 天生存率方面相似。这表明利用当地外科团队的专业知识是降低与心脏同种异体移植物获取相关的行程风险、财务支出和机会成本的一种安全有效的方法。
