Nguyen Anh, Rana Abbas, Shafii Alexis, Loor Gabriel, Civitello Andrew, Reyes Jose Euberto Mendez, Frazier O Howard, Rosengart Todd, Liao Kenneth
Division of Cardiothoracic Transplantation and Circulatory Support, Department of Surgery, Baylor College of Medicine, Houston, Texas.
Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, Texas.
JHLT Open. 2025 Jul 10;9:100342. doi: 10.1016/j.jhlto.2025.100342. eCollection 2025 Aug.
This study builds upon previous analyses by examining heart transplant survival from donation after circulatory death (DCD) vs donation after brain death (DBD) using the United Network for Organ Sharing (UNOS) database, with follow-up extended to 3 years post-transplant.
We conducted a retrospective cohort study of 1,453 DCD and 16,561 DBD adult heart transplants from January 2019 to June 2024 using the UNOS database. Propensity scores were generated based on clinically relevant covariates, and 1-to-1 propensity-score matching was performed. Survival analysis was conducted using Cox proportional hazards regression and Kaplan-Meier curves, with the log-rank test comparing overall survival and the Wald test examining yearly survival rates between DCD and DBD groups.
Mortality was not significantly different between DCD and DBD total cohorts (hazard ratio [HR] = 1.1, 95% confidence interval [CI] 0.9-1.3, = 0.493). After propensity-score matching, balanced cohorts of 1,423 DCD and 1,423 DBD transplants were created with standardized mean difference among covariates well below 6%. In the matched cohort, DCD transplant mortality was 1.2 times higher than that of DBD transplants (HR 1.2, 95% CI 0.9-1.5). Kaplan-Meier curves revealed nonsignificantly lower overall survival for DCD recipients (log-rank = 0.096). Survival rates were comparable in year 1: 91.6% vs 91.5%, = 0.96, but significant differences emerged in subsequent years: 84.7% vs 89.4%, = 0.007 in year 2; 80.3% vs 85.6%, = 0.025 in year 3.
Intermediate-term survival following DCD heart transplantation may be lower compared to DBD transplantation. Further investigation is warranted to identify the underlying factors contributing to this potential disparity.
本研究在先前分析的基础上，利用器官共享联合网络（UNOS）数据库，对心脏移植受者在循环死亡后捐赠（DCD）与脑死亡后捐赠（DBD）情况下的生存情况进行了研究，并将随访期延长至移植后3年。
我们使用UNOS数据库对2019年1月至2024年6月期间的1453例DCD成人心脏移植和16561例DBD成人心脏移植进行了回顾性队列研究。根据临床相关协变量生成倾向得分，并进行1:1倾向得分匹配。使用Cox比例风险回归和Kaplan-Meier曲线进行生存分析，采用对数秩检验比较总生存率，采用Wald检验检查DCD组和DBD组之间的年度生存率。
DCD组和DBD组总队列的死亡率无显著差异（风险比[HR]=1.1，95%置信区间[CI]0.9-1.3，P=0.493）。倾向得分匹配后，创建了1423例DCD移植和1423例DBD移植的平衡队列，协变量之间的标准化平均差异远低于6%。在匹配队列中，DCD移植死亡率比DBD移植高1.2倍（HR 1.2，95%CI 0.9-1.5）。Kaplan-Meier曲线显示DCD受者的总生存率略低，但无统计学意义（对数秩P=0.096）。第1年的生存率相当：91.6%对91.5%，P=0.96，但随后几年出现显著差异：第2年为84.7%对89.4%，P=0.007；第3年为80.3%对85.6%，P=0.025。
与DBD心脏移植相比，DCD心脏移植的中期生存率可能较低。有必要进一步调查以确定导致这种潜在差异的潜在因素。
