Boucek M M, Mathis C M, Kanakriyeh M S, McCormack J, Razzouk A, Gundry S R, Bailey L
Division of Pediatric Cardiology, Loma Linda University Medical Center, Calif.
J Heart Lung Transplant. 1993 Nov-Dec;12(6 Pt 2):S186-90.
The cause of brain death and the physiologic sequelae of brain death may impair heart function. Pharmacologic attempts to maintain donor viability may further jeopardize myocardial performance and could only be justified if dysfunctional donor organs subsequently prove to recover normal function after transplantation. Survival data on heart transplantation with organs donated from infants with sudden infant death syndrome indicate that prolonged ischemia (cardiopulmonary resuscitation up to 60 minutes) and metabolic abnormalities a priori do not increase the risk of graft failure. To provide a donor organ to infants in immediate peril, we have used donor hearts with documented dysfunction (left ventricular shortening fraction [LVSF] < 28%, wall motion abnormalities, and mitral regurgitation). The results of heart transplantation with use of dysfunctional donor hearts (n = 22, LVSF = 24.5% +/- 3%) were compared with donors with normal left ventricular function (n = 133, LVSF > 28%). Early death (< 30 days) was similar for the dysfunctional donor group (14%) and normal function donor group (11%). Postoperative inotropic support was equally frequent in both groups. Graft function on echocardiography was normal at 30 days after transplantation for both types of donor organs. We conclude that donor hearts with decreased left ventricular function (LVSF 15% to 28% and/or asymmetric wall motion), despite massive inotropic support, can function normally in the recipient. Significant donor mitral regurgitation was seen in grafts that ultimately failed after transplantation. Research into the reversible mechanisms of myocardial dysfunction associated with brain death could enlarge the donor pool.
脑死亡的原因以及脑死亡的生理后遗症可能会损害心脏功能。使用药物维持供体存活的尝试可能会进一步危及心肌性能，只有在功能失调的供体器官随后在移植后证明恢复正常功能时，这种做法才合理。关于使用婴儿猝死综合征婴儿捐赠的器官进行心脏移植的存活数据表明，长时间缺血（心肺复苏长达60分钟）和先验代谢异常并不会增加移植失败的风险。为了给处于紧急危险中的婴儿提供供体器官，我们使用了有功能障碍记录的供体心脏（左心室缩短分数[LVSF]<28%、室壁运动异常和二尖瓣反流）。将使用功能障碍供体心脏（n = 22，LVSF = 24.5%±3%）进行心脏移植的结果与左心室功能正常的供体（n = 133，LVSF>28%）进行了比较。功能障碍供体组（14%）和正常功能供体组（11%）的早期死亡（<30天）相似。两组术后使用正性肌力药物支持的频率相同。移植后30天，两种类型供体器官的移植心脏在超声心动图上的功能均正常。我们得出结论，尽管给予大量正性肌力药物支持，但左心室功能降低（LVSF为15%至28%和/或室壁运动不对称）的供体心脏在受体中仍可正常发挥功能。在移植后最终失败的移植物中可见明显的供体二尖瓣反流。对与脑死亡相关的心肌功能障碍的可逆机制进行研究可能会扩大供体库。
