Overbey Douglas M, Kucera John A, Aykut Berk, Wolf Seth E M, Gambino Rachel M, Medina Cathlyn K, Shea Erin V, Schroder Jacob N, Turek Joseph W
Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC; Duke Children's Pediatric and Congenital Heart Center, Durham, NC.
Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC.
J Thorac Cardiovasc Surg. 2025 Jun 20. doi: 10.1016/j.jtcvs.2025.06.015.
Orthotopic heart transplant is the definitive option for pediatric patients with end-stage heart failure. Unfortunately, the greatest contributor to waitlist mortality has been a shortage of available hearts for transplant. Donation after circulatory death with normothermic regional perfusion may mitigate this supply-demand mismatch.
Donation after circulatory death with normothermic regional perfusion recipients were matched to similar donation after brain death recipients. Primary end points included 1-year survival and episodes of primary graft dysfunction at 1 year. Secondary end points included treated rejection at 1 year and ventricular systolic and diastolic function on echocardiogram at time of discharge. Elevated filling pressures or decreased cardiac output were also examined via cardiac catheterization data at time of endomyocardial biopsy at 1 year.
Twelve donation after circulatory death procurements were attempted and 9 hearts procured. Donor cardiac arrest and cardiac function before procurement were similar in both groups. Donation after brain death recipients spent more time on the waitlist. After transplant, biventricular function was similar in both groups at time of discharge and at 1-year follow-up. There were no differences between groups with regard to primary graft dysfunction or instances of treated rejection at 1 year.
This study represents the largest single-institution cohort of pediatric recipients of hearts obtained after donation after circulatory death with normothermic regional perfusion compared with demographically similar donation after brain death cardiac transplant recipients. These results are indicative of equivalent outcomes at 1-year, suggesting that donation after circulatory death with normothermic regional perfusion is a viable method to expand the pediatric cardiac donor pool.
原位心脏移植是终末期心力衰竭儿科患者的最终治疗选择。不幸的是，等待名单上死亡率的最大影响因素是可用于移植的心脏短缺。常温区域灌注下循环死亡后捐赠可能会缓解这种供需不匹配的情况。
将常温区域灌注下循环死亡后捐赠的受者与脑死亡后捐赠的类似受者进行匹配。主要终点包括1年生存率和1年时原发性移植物功能障碍的发作情况。次要终点包括1年时的治疗性排斥反应以及出院时超声心动图检查的心室收缩和舒张功能。还通过1年时心肌内膜活检时的心脏导管检查数据检查充盈压升高或心输出量降低的情况。
尝试进行了12例循环死亡后捐赠获取，获得了9颗心脏。两组捐赠者心脏骤停和获取前的心脏功能相似。脑死亡后捐赠的受者在等待名单上花费的时间更长。移植后，两组在出院时和1年随访时的双心室功能相似。两组在1年时原发性移植物功能障碍或治疗性排斥反应情况方面没有差异。
与人口统计学上相似的脑死亡后心脏移植受者相比，本研究代表了常温区域灌注下循环死亡后捐赠获取心脏的儿科受者的最大单机构队列。这些结果表明1年时结果相当，表明常温区域灌注下循环死亡后捐赠是扩大儿科心脏供体库的一种可行方法。
