New Approaches to Donor Selection and Preparation in Heart Transplantation.
New Approaches to Donor Selection and Preparation in Heart Transplantation.
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DOI：
10.1007/s11936-021-00906-5
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发表时间：
2021
影响因子：
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通讯作者：
Khush KK
中科院分区：
文献类型：
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作者：
Tong CKW;Khush KK
随着D期心力衰竭患者生存率的提高，对心脏移植的需求也在增加。供体心脏的供应仍然相对有限。已经研究了各种战略，并开发了新的技术，以扩大目前的捐助者。这些新方法将在这里讨论。由于年龄较大、大小与预期受体不匹配、缺血时间延长、左心室肥厚和乙型/丙型肝炎感染等危险因素，供体心脏通常被认为是“边缘”的。我们回顾了最近关于使用具有这些危险因素的供体心脏的数据，并提出了安全放宽目前供体心脏接受标准的方法。与常规冷藏相比，温控运输系统和体外心脏灌注方法等新技术也证明了有希望的短期和中期结果，这些技术促进了心脏保存，并使心脏能够在较短的冷缺血时间内从偏远地区获取。最近使用循环死亡供者捐赠的心脏已显示出与脑死亡后传统捐赠相当的结果，这可以进一步扩大目前的供者库。仔细选择“边缘”供体心脏，使用体外心脏灌注，以及接受循环死亡后的心脏，可以扩大我们目前的心脏供体库，其结果与传统的供体选择和制备方法相当。
With increasing survival of patients with stage D heart failure, the demand for heart transplantation has increased. The supply of donor hearts remains relatively limited. Strategies have been investigated and new technologies have been developed to expand the current donor pool. These new approaches will be discussed herein. Donor hearts are often considered “marginal” due to risk factors such as older age, size mismatch with the intended recipient, prolonged ischemic time, presence of left ventricular hypertrophy, and hepatitis B/C infection. We reviewed recent data regarding the use of donor hearts with these risk factors and suggest ways to safely liberalize current donor heart acceptance criteria. New technologies such as temperature-controlled transport systems and ex vivo cardiac perfusion methods have also demonstrated promising short-term and intermediate outcomes as compared with routine cold storage, by promoting heart preservation and enabling heart procurement from remote sites with shorter cold ischemic time. Recent use of hearts from donation after circulatory death donors has demonstrated comparable outcomes to conventional donation after brain death, which can further expand the current donor pool. Careful selection of “marginal” donor hearts, use of ex vivo cardiac perfusion, and acceptance of hearts after circulatory death may expand our current cardiac donor pool with comparable outcomes to conventional donor selection and preparation methods.