Wisniewski Alex M, Weber Matthew P, Kareddy Abhinav, Teman Nicholas R, Beller Jared P, Yarboro Leora T
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia Medical Center, Charlottesville, Va.
JTCVS Open. 2025 Jan 31;24:311-320. doi: 10.1016/j.xjon.2024.12.014. eCollection 2025 Apr.
Cardiac donation after circulatory death has increased in utilization with results comparable to donation after brain death in adult patients undergoing heart transplantation. However, its use in adult congenital heart disease (ACHD) is not well studied. We aimed to characterize outcomes of cardiac donation after circulatory death in an ACHD population.
Utilizing the United Network for Organ Sharing database, patients with ACHD who underwent heart transplantation between January 2020 and January 2024 were identified. Those with any prior heart transplant or undergoing multiorgan transplant were excluded. Kaplan-Meier survival analysis and Cox regression were used for group survival comparisons.
A total of 420 adult patients with congenital heart disease undergoing heart transplant met inclusion criteria with 36 patients receiving donation after circulatory death grafts. Circulatory death grafts were from a similar median distance (273 vs 222 miles) but had longer ischemic times (4.7 vs 3.8 hours) and higher use of ex situ perfusion devices (66.7% vs 5.7%; < .001). Kaplan-Meier analysis demonstrated significantly worse 90-day survival after transplant in the donation after circulatory death group (log-rank = .039) but no difference on landmark analysis for survivors after 90 days (log-rank = .43).
Early results of circulatory death grafts compared with brain death grafts in adult patients with congenital heart disease undergoing heart transplantation have demonstrated worse early survival but similar midterm survival following 90 days. Attention should be placed on improving outcomes during the perioperative period to effectively utilize this potential expanded donor pool in ACHD.
在接受心脏移植的成年患者中，循环死亡后心脏捐赠的利用率有所提高，其结果与脑死亡后捐赠相当。然而，其在成人先天性心脏病（ACHD）中的应用尚未得到充分研究。我们旨在描述ACHD人群中循环死亡后心脏捐赠的结果。
利用器官共享联合网络数据库，确定2020年1月至2024年1月期间接受心脏移植的ACHD患者。排除那些曾接受过心脏移植或正在接受多器官移植的患者。采用Kaplan-Meier生存分析和Cox回归进行组间生存比较。
共有420例接受心脏移植的成年先天性心脏病患者符合纳入标准，其中36例接受了循环死亡后捐赠的移植物。循环死亡后捐赠的移植物来自类似的中位距离（273英里对222英里），但缺血时间更长（4.7小时对3.8小时），异位灌注装置的使用频率更高（66.7%对5.7%；P<0.001）。Kaplan-Meier分析显示，循环死亡后捐赠组移植后90天的生存率明显更差（对数秩检验=0.039），但在90天后幸存者的标志性分析中无差异（对数秩检验=0.43）。
在接受心脏移植的成年先天性心脏病患者中，与脑死亡后捐赠的移植物相比，循环死亡后捐赠的移植物早期结果显示早期生存率较差，但90天后的中期生存率相似。应关注围手术期改善结果，以有效利用ACHD中这一潜在扩大的供体库。
