Karatasakis Aris, Silvestri Edwin Grajeda, Nair Gatha G, Zuniga Benjamin, Li Song, Mahr Claudius, Cheng Richard K, Stempien-Otero April S, Dimarakis Ioannis, Khorsandi Maziar, Pal Jay D, Kizer Jorge R, Simon Marc A, Bravo Claudio A
Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA.
Presbyterian Heart & Vascular Care, Albuquerque, New Mexico, USA.
ESC Heart Fail. 2025 Jun 26. doi: 10.1002/ehf2.15357.
Donation after circulatory death (DCD) has emerged as a strategy to increase the donor pool for heart transplantation (HT). Left ventricular assist device (LVAD) patients represent a discrete and unique population. We sought to explore the early outcomes of DCD-HT compared with donation after brain death (DBD) HT in LVAD patients.
We obtained data from the United Network of Organ Sharing database. The main cohort consisted of adults listed for HT between 17 October 2018 and 3 July 2024, with LVAD implanted before or after listing. The primary outcome was survival within the first year post-HT. There were 3336 patients with LVAD underwent HT during the study period (median age 55 years (interquartile range 45-62), 24% women, 29% Black, 89% DBD). The short-term post-HT mortality in LVAD patients who underwent DCD HT was not significantly different from DBD (adjusted hazard ratio [aHR] 1.00, 95% CI 0.70-1.42, P value > 0.9). The likelihood of transplantation within 1 year was higher at centres performing DCD (aHR 1.44, 95% CI 1.39-1.49, P < 0.001). Despite the longer donor-recipient distance in DCD-HT, in-hospital outcomes (stroke and acute kidney injury requiring dialysis) were not different from DBD-HT. A higher incidence of primary graft dysfunction (adjusted risk ratio [aRR] 3.8, 95% CI 2.5-5.7, P < 0.001), and treated rejection was observed with DCD-HT (aRR 1.48, 95% CI 1.14-1.93, P = 0.003).
In LVAD patients who received DCD HT, early post-transplant survival, stroke, acute kidney injury and length of stay were not significantly different from those who underwent DBD HT. There were increased rates of primary graft dysfunction and treated rejection among LVAD patients who underwent DCD HT. Patients in a DCD centre were significantly more likely to be transplanted earlier.
心脏死亡后器官捐献（DCD）已成为一种增加心脏移植（HT）供体库的策略。左心室辅助装置（LVAD）患者是一个独特的群体。我们试图探讨LVAD患者中DCD-HT与脑死亡后器官捐献（DBD）HT的早期结局。
我们从器官共享联合网络数据库获取数据。主要队列包括2018年10月17日至2024年7月3日期间登记接受HT的成年人，LVAD在登记前或登记后植入。主要结局是HT后第一年内的生存率。在研究期间，有3336例LVAD患者接受了HT（中位年龄55岁（四分位间距45 - 62岁），24%为女性，29%为黑人，89%为DBD）。接受DCD HT的LVAD患者HT后的短期死亡率与DBD无显著差异（调整后风险比[aHR] 1.00，95%置信区间0.70 - 1.42，P值> 0.9）。在进行DCD的中心，1年内移植的可能性更高（aHR 1.44，95%置信区间1.39 - 1.49，P < 0.001）。尽管DCD-HT中供体与受体的距离更长，但住院结局（中风和需要透析的急性肾损伤）与DBD-HT并无差异。观察到DCD-HT的原发性移植物功能障碍发生率更高（调整后风险比[aRR] 3.8，95%置信区间2.5 - 5.7，P < 0.001），且治疗性排斥反应也更高（aRR 1.48，95%置信区间1.14 - 1.93，P = 0.003）。
在接受DCD HT的LVAD患者中，移植后早期生存率、中风、急性肾损伤和住院时间与接受DBD HT的患者无显著差异。接受DCD HT的LVAD患者中原发性移植物功能障碍和治疗性排斥反应的发生率有所增加。在DCD中心的患者更早接受移植的可能性显著更高。
