Zeraatiannejaddavani Sam, Shahrbaf Mohammadamin, Kamalzadeh Nazafarin, Shafikhani Yazdan
From the Canning Thoracic Institute, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; and the Department of Cardiovascular and Transplant Surgery, Organ Procurement Unit, Iran University of Medical Sciences, Tehran, Iran.
Exp Clin Transplant. 2025 May;23(5):317-327. doi: 10.6002/ect.2025.0089.
Donation after circulatory death offers a promising solution to expand the thoracic organ donor pool, yet its application remains limited because of warm ischemia and technical barriers, especially in uncontrolled donation after circulatory death. We aimed to evaluate a pulsatile normothermic car-diopulmonary bypass-based strategy for thoracic organ recovery of uncontrolled donors after circulatory death and the effects of this strategy on graft function and recipient outcomes.
In this prospective single-center study, we studied thoracic organs recovered from uncontrolled donors after circulatory death after ≥60 minutes of unsuccessful cardiopulmonary resuscitation. After heparinization and pharmacologic optimization, donors underwent median sternotomy and were connected to a cardiopulmonary bypass circuit with pulsatile flow. Organ assessment was performed in vivo. Donor, graft, and recipient functional data were recorded, with follow-up results studied through at least 1 year.
Forty-two donors were included. All hearts (n = 42) and 40 lungs (from 84 donors) were successfully transplanted. Despite prolonged cardiopulmonary resuscitation, no graft failure or recipient mortality occurred. One year survival for both heart and lung recipients was 100%. Heart grafts showed progressive improvement in functional status, including left ventricular ejection fraction, lactate levels, and New York Heart Association classification; lungs demonstrated sustained gains in gas exchange, pulmonary function tests, and 6-minute walk distance. Mild primary graft dysfunction (grade 1-2) occurred in 10% of lung recipients (all unilateral transplants). Pericardial effusion increased, likely because of trauma before procurement, but resolved without effects on function.
Pulsatile normothermic cardiopulmonary bypass enables successful procurement of thoracic organs from uncontrolled donors after circulatory death with excellent outcomes. This low-cost physiological approach may offer a viable strategy to expand availability of donors in resource-limited settings.
循环死亡后器官捐献为扩大胸段器官供体库提供了一个有前景的解决方案，但其应用由于热缺血和技术障碍仍然有限，尤其是在非可控性循环死亡后器官捐献中。我们旨在评估一种基于搏动性常温体外循环的策略用于非可控性循环死亡供体的胸段器官获取，以及该策略对移植物功能和受体结局的影响。
在这项前瞻性单中心研究中，我们研究了在心肺复苏≥60分钟未成功后从非可控性循环死亡供体获取的胸段器官。肝素化和药物优化后，供体接受正中胸骨切开术，并连接到具有搏动血流的体外循环回路。在体内进行器官评估。记录供体、移植物和受体的功能数据，并对至少1年的随访结果进行研究。
纳入42例供体。所有心脏（n = 42）和40个肺（来自84例供体）均成功移植。尽管心肺复苏时间延长，但未发生移植物失败或受体死亡。心脏和肺受体的1年生存率均为100%。心脏移植物的功能状态逐渐改善，包括左心室射血分数、乳酸水平和纽约心脏协会分级；肺在气体交换、肺功能测试和6分钟步行距离方面持续改善。10%的肺受体（均为单侧移植）发生轻度原发性移植物功能障碍（1 - 2级）。心包积液增加，可能是由于获取前的创伤，但积液消退且未对功能产生影响。
搏动性常温体外循环能够成功地从非可控性循环死亡供体获取胸段器官，且效果良好。这种低成本的生理学方法可能为在资源有限的环境中扩大供体可用性提供一种可行的策略。
