Rust Clayton J, Reul Ross Michael, Abadiotakis Helen, Kodimerla Reshma, Preston Joshua D, Randhawa Supreet S, Halkos Michael E, Bishawi Muath M, Daneshmand Mani A, Chan Joshua L
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30345, USA.
J Clin Med. 2025 May 29;14(11):3809. doi: 10.3390/jcm14113809.
: Donation after circulatory death (DCD) has emerged to expand the heart-donor pool, but many DCD donors have risk factors such as cocaine or methamphetamine use. Stimulant use can cause coronary vasospasm and premature coronary artery disease, leading to routine donor coronary angiography (left heart catheterization, LHC) for coronary screening. However, performing LHC in DCD donors is challenging. We examined whether omitting LHC in stimulant-exposed DCD donors affects outcomes. : A retrospective analysis was performed using the United Network for Organ Sharing (UNOS) database (2019-2024) to identify adult heart transplant recipients from DCD donors with documented cocaine or amphetamine use. Donors were stratified by whether antemortem LHC was performed. The primary outcome was 1-year recipient survival; secondary outcomes included graft failure and acute rejection. Kaplan-Meier survival curves and Cox regression analyses were performed. : A total of 485 DCD heart transplant recipients were identified; 135 (28%) donors underwent LHC and 350 (72%) did not. Recipient characteristics were similar between groups. No significant differences in 30-day (6% vs. 3%; = 0.11), 90-day (6% vs. 3%; = 0.21), or 1-year survival (7% vs. 6%; = 0.48) were observed between the LHC and non-LHC cohorts. Graft failure and complication rates were also similar. However, among stimulant-exposed DCD donors with diabetes, an absence of LHC was associated with higher recipient mortality (HR 5.86, 95% CI: 1.57-21.87; = 0.008). : Routine donor coronary angiography may be unnecessary for stimulant-exposed DCD donors without additional risk factors. Omitting LHC did not compromise transplant outcomes. A selective LHC approach for high-risk DCD donors (e.g., diabetic donors) could safely expand the donor pool.
循环性死亡后器官捐献（DCD）已出现以扩大心脏供体库，但许多DCD供体存在诸如使用可卡因或甲基苯丙胺等风险因素。使用兴奋剂会导致冠状动脉痉挛和过早出现冠状动脉疾病，从而导致对供体进行常规冠状动脉血管造影（左心导管插入术，LHC）以进行冠状动脉筛查。然而，在DCD供体中进行LHC具有挑战性。我们研究了在接触兴奋剂的DCD供体中省略LHC是否会影响结果。：使用器官共享联合网络（UNOS）数据库（2019 - 2024年）进行回顾性分析，以识别来自有记录使用可卡因或苯丙胺的DCD供体的成年心脏移植受者。根据是否进行生前LHC对供体进行分层。主要结局是受者1年生存率；次要结局包括移植物失败和急性排斥反应。进行了Kaplan - Meier生存曲线和Cox回归分析。：共识别出485名DCD心脏移植受者；135名（28%）供体进行了LHC，350名（72%）未进行。两组间受者特征相似。LHC组和非LHC组在30天（6%对3%；P = 0.11）、90天（6%对3%；P = 0.21）或1年生存率（7%对6%；P = 0.48）方面未观察到显著差异。移植物失败和并发症发生率也相似。然而，在患有糖尿病的接触兴奋剂的DCD供体中，未进行LHC与较高的受者死亡率相关（风险比5.86，95%置信区间：1.57 - 21.87；P = 0.008）。：对于没有其他风险因素的接触兴奋剂的DCD供体，常规供体冠状动脉血管造影可能不必要。省略LHC不会损害移植结果。对高风险DCD供体（如糖尿病供体）采用选择性LHC方法可安全地扩大供体库。
