Akbar Armaan F, Zhou Alice L, Ruck Jessica M, Pasrija Chetan, Polanco Antonio, Kilic Ahmet
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
J Heart Lung Transplant. 2025 Jul 9. doi: 10.1016/j.healun.2025.06.032.
In recent years, machine perfusion (MP) for heart transplantation has been increasingly adopted in the United States. However, pragmatic national studies on the utilization and outcomes of this practice are lacking.
Adult (≥18 years) heart recipients transplanted between October 18, 2018 and September 30, 2023 in the United Network for Organ Sharing database were included. We compared outcomes of MP and non-MP transplants among donation after brain death (DBD) and circulatory death (DCD) donors. We used Cox regression to evaluate survival at 30 days and 1 year post-transplant.
Of 13,500 DBD transplants, 403 (3.0%) utilized MP. Donors of MP vs non-MP grafts were older (34 vs 32 years, p = 0.003) and traveled longer distances to the recipient center (478 vs 228 nautical miles, p < 0.001). Recipients of MP vs non-MP DBD grafts had increased risk of predischarge dialysis (adjusted odds ratio (aOR) 1.33 [95% confidence interval (CI): 1.01-1.75], p = 0.04) and predischarge stroke (aOR 1.66 [95% CI: 1.08-2.55], p = 0.02), but similar hazards of mortality at 30 days (adjusted hazard ratio (aHR) 1.01 [95% CI: 0.54-1.86], p = 0.99) and 1 year (aHR 0.98 [95% CI: 0.66-1.43], p = 0.90). Of 976 DCD transplants, 633 (64.9%) utilized MP. Recipients of MP vs non-MP DCD grafts had similar risks of dialysis (aOR 1.19 [95% CI: 0.82-1.72], p = 0.36) and stroke (aOR 1.68 [95% CI: 0.82-3.49, p = 0.16), and similar hazard of 30-day (aHR 1.62 [95% CI: 0.67-3.94], p = 0.28), and 1-year mortality (aHR 0.91 [95% CI: 0.54-1.54], p = 0.73).
MP use in heart transplantation was associated with favorable outcomes, suggesting it has the potential to increase donor heart utilization, particularly for donors with long projected ischemic times.
近年来，心脏移植的机器灌注（MP）在美国越来越多地被采用。然而，缺乏关于这种做法的使用情况和结果的实用性全国性研究。
纳入2018年10月18日至2023年9月30日期间在器官共享联合网络数据库中接受移植的成年（≥18岁）心脏受者。我们比较了脑死亡后捐赠（DBD）和循环死亡（DCD）供体中MP移植和非MP移植的结果。我们使用Cox回归评估移植后30天和1年的生存率。
在13500例DBD移植中，403例（3.0%）使用了MP。MP移植物与非MP移植物的供体年龄更大（34岁对32岁，p = 0.003），到受者中心的行程更远（478海里对228海里，p < 0.001）。MP DBD移植物与非MP DBD移植物的受者出院前透析风险增加（调整优势比（aOR）1.33 [95%置信区间（CI）：1.01 - 1.75]，p = 0.04）和出院前中风风险增加（aOR 1.66 [95% CI：1.08 - 2.55]，p = 0.02），但30天（调整风险比（aHR）1.01 [95% CI：0.54 - 1.86]，p = 0.99）和1年（aHR 0.98 [95% CI：0.66 - 1.43]，p = 0.90）的死亡风险相似。在976例DCD移植中，633例（64.9%）使用了MP。MP DCD移植物与非MP DCD移植物的受者透析风险（aOR 1.19 [95% CI：0.82 - 1.72]，p = 0.36）和中风风险（aOR 1.68 [95% CI：0.82 - 3.49，p = 0.16]）相似，30天（aHR 1.62 [95% CI：0.67 - 3.94]，p = 0.28）和1年死亡率（aHR 0.91 [95% CI：0.54 - 1.54]，p = 0.73）也相似。
心脏移植中使用MP与良好的结果相关，表明它有可能提高供体心脏的利用率，特别是对于预计缺血时间长的供体。
