Oaks T E, Aravot D, Dennis C, Wells F C, Large S R, Wallwork J
Transplant Unit, Papworth Hospital, Cambridge, United Kingdom.
J Heart Lung Transplant. 1994 May-Jun;13(3):433-7.
The use of donor hearts from heart-lung recipients, the so-called domino procedure, began at Papworth Hospital in November 1988. Between then and September 1992, 198 heart transplantations and 86 heart-lung transplantations were performed. Fifty-three heart-lung recipients donated their hearts for use in the domino procedure. Thirty-two domino hearts were transplanted at Papworth and 21 were exported to other centers. Institution of the domino procedure allowed us to perform 19% more heart transplantations (166 to 198) than would have been done had the procedure not been used. The ischemic time was significantly shorter for the domino hearts compared with organs from brain dead donors (134 minutes versus 191 minutes; p < 0.001). No difference was found in the 3-month (84% versus 83%) or 1-year (74% versus 76%) survival between domino and nondomino recipients. Other potential advantages of the domino procedure include detailed pretransplantation evaluation of the heart in live donors and the potential for human leukocyte antigen matching. Additionally many heart-lung recipients have elevated pulmonary artery pressures and a "conditioned", hypertrophied right ventricle. The use of such hearts for heart transplantation has theoretic appeal for patients with elevated pulmonary vascular resistance.
1988年11月，帕普沃思医院开始使用心肺移植受者的供心，即所谓的多米诺手术。从那时起到1992年9月，共进行了198例心脏移植和86例心肺移植。53例心肺移植受者捐献了他们的心脏用于多米诺手术。32颗多米诺心脏在帕普沃思医院进行了移植，21颗被运往其他中心。多米诺手术的实施使我们能够比不采用该手术时多进行19%的心脏移植（从166例增加到198例）。与脑死亡供者的器官相比，多米诺心脏的缺血时间明显更短（134分钟对191分钟；p<0.001）。多米诺受者和非多米诺受者在3个月（84%对83%）或1年（74%对76%）生存率方面没有差异。多米诺手术的其他潜在优势包括对活体供者心脏进行详细的移植前评估以及进行人类白细胞抗原配型的可能性。此外，许多心肺移植受者肺动脉压力升高，右心室“适应性”肥厚。对于肺血管阻力升高的患者，使用这样的心脏进行心脏移植具有理论上的吸引力。
