Shin Max, Toubat Omar, Catalano Michael A, Iyengar Amit, Helmers Mark R, Asher Michaela, Rekhtman David, Song Cindy, Biscotti Mauer, Cevasco Marisa
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Heart Fail. 2025 Aug;13(8):102495. doi: 10.1016/j.jchf.2025.03.039. Epub 2025 Jun 16.
Recent advances in heart procurement techniques have facilitated the utilization of hearts obtained after circulatory death. However, discerning the population that stands to benefit most requires an understanding of waitlist outcomes.
The objective of this study was to evaluate waitlist and post-transplant outcomes among patients listed for donation after circulatory death (DCD) hearts in the United States, stratified by listing status.
The UNOS (United Network for Organ Sharing) database was queried for all adult patients waitlisted for isolated heart transplantation between October 2018 and June 2024. Patients were stratified by approval for donation after brain death vs DCD hearts. DCD patients were subdivided into those who were DCD candidates at time of listing or later during their waitlist period. Waitlist and post-transplant outcomes were compared using Fine & Gray and Kaplan-Meier analyses.
A total of 24,970 patients were identified; of these, 8,191 (33%) were listed as DCD candidates. DCD status 2, 3, 4, and 6 patients were more likely to be transplanted and less likely to die on the waitlist. There were no differences in post-transplant survival in any group. Receipt of a DCD heart was not predictive of mortality. Patients initially listed as DCD candidates were significantly more likely to be transplanted than those who became DCD candidates later during their waitlist course.
With exception of status 1, patients waitlisted for DCD hearts experience shorter waitlist duration, improved rates of transplantation, and comparable long-term survival with donation after brain death recipients.
心脏获取技术的最新进展促进了对循环性死亡后获取的心脏的利用。然而，要确定最有可能受益的人群，需要了解等待名单上的结果。
本研究的目的是评估美国等待循环性死亡（DCD）心脏捐赠的患者的等待名单和移植后结果，并按列入状态进行分层。
查询器官共享联合网络（UNOS）数据库，以获取2018年10月至2024年6月期间所有等待孤立心脏移植的成年患者。患者按脑死亡后捐赠批准情况与DCD心脏进行分层。DCD患者被细分为在列入名单时或在等待名单期间后期成为DCD候选者的患者。使用Fine&Gray和Kaplan-Meier分析比较等待名单和移植后结果。
共识别出24970名患者；其中，8191名（33%）被列为DCD候选者。DCD状态2、3、4和6的患者更有可能接受移植，在等待名单上死亡的可能性更小。任何组的移植后生存率均无差异。接受DCD心脏并不能预测死亡率。最初列为DCD候选者的患者比在等待名单过程中后来成为DCD候选者的患者更有可能接受移植。
除状态1外，等待DCD心脏的患者等待名单持续时间较短，移植率提高，与脑死亡后捐赠受者的长期生存率相当。
