Heart transplantation using donation after circulatory death in the United States.
Heart transplantation using donation after circulatory death in the United States.
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在美国，循环死亡后使用捐赠进行心脏移植。
DOI：
10.1016/j.jtcvs.2022.05.005
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Catarino,Pedro
中科院分区：
文献类型：
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作者：
Chen,Qiudong;Emerson,Dominic;Megna,Dominick;Osho,Asishana;Roach,Amy;Chan,Joshua;Rowe,Georgina;Gill,George;Esmailian,Fardad;Chikwe,Joanna;Egorova,Natalia;Kirklin,JamesK;Kobashigawa,Jon;Catarino,Pedro
美国最近重新引入了循环死亡后的心脏捐献，希望增加供体心脏的可用性。我们检查了其国家使用和outcomes.MethodsThe器官共享联合网络数据库被用来确定经过验证的成年患者接受心脏移植后，使用循环死亡供体（n = 266）和脑死亡供体（n = 5998）捐赠后捐赠2019年12月1日至2021年12月31日，排除心肺移植后。结果循环死亡心脏移植后每月捐赠的百分比从2019年12月的2. 5%增加到2021年12月的6. 8%（P<0. 001）。22个中心在循环死亡心脏移植后进行捐赠，每个中心的移植数量从1到75不等。四个中心完成了全国总量的70%。循环死亡心脏后的捐赠者更有可能临床稳定（80.4% vs 41.1%，状态3-6，P< .001），O型血（58.3%vs39.9%，P <0.001），并等待更长时间后上市（55，四分位距，15-180天vs 32，四分位距，9-160天，P= 0.003）。脑死亡心脏移植后捐献的6个月存活率为92.1%（95%可信区间，91.3-92.8），循环死亡心脏移植后捐献的6个月存活率为92.6%（95%可信区间，88.1-95.4）（风险比，0.94，95%可信区间，0.57- 1.54，P = 0.79）。倾向匹配的患者的结局相似，除了出院前循环死亡移植后捐赠的经治疗急性排斥反应发生率较高（14.4%vs8.8%，P = 0.01）。在捐赠后循环死亡心脏收件人，结果并没有不同的采购技术（常温区域灌注与直接采购和灌注）。ConclusionsHeart transplantation with donation after circulating death donors has short-term survival compared to donation after brain death transplants.更广泛的执行可以大大增加捐赠器官的供应。
ObjectivesHeart donation after circulatory death was recently reintroduced in the United States with hopes of increasing donor heart availability. We examined its national use and outcomes.MethodsThe United Network for Organ Sharing database was used to identify validated adult patients undergoing heart transplantation using donation after circulatory death donors (n = 266) and donation after brain death donors (n = 5998) between December 1, 2019, and December 31, 2021, after excluding heart-lung transplants. Propensity score matching was used to create more balanced groups for comparison.ResultsThe monthly percentage of donation after circulatory death heart transplant increased from 2.5% in December 2019 to 6.8% in December 2021 (P< .001). Twenty-two centers performed donation after circulatory death heart transplants, ranging from 1 to 75 transplants per center. Four centers performed 70% of the national volume. Recipients of donation after circulatory death hearts were more likely to be clinically stable (80.4% vs 41.1% in status 3-6,P< .001), to have type O blood (58.3% vs 39.9%,P< .001), and to wait longer after listing (55, interquartile range, 15-180 days vs 32, interquartile range, 9-160 days,P= .003). Six-month survival was 92.1% (95% confidence interval, 91.3-92.8) after donation after brain death heart transplants and 92.6% (95% confidence interval, 88.1-95.4) after donation after circulatory death heart transplants (hazard ratio, 0.94, 95% confidence interval, 0.57-1.54,P= .79). Outcomes in propensity-matched patients were similar except for higher rates of treated acute rejection in donation after circulatory death transplants before discharge (14.4% vs 8.8%,P= .01). In donation after circulatory death heart recipients, outcomes did not differ based on the procurement technique (normothermic regional perfusion vs direct procurement and perfusion).ConclusionsHeart transplantation with donation after circulatory death donors has short-term survival comparable to donation after brain death transplants. Broader implementation could substantially increase donor organ availability.