A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors
A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors
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DOI：
10.1016/j.healun.2020.10.001
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发表时间：
2020-12-01
影响因子：
8.9
通讯作者：
Large, Stephen R.
中科院分区：
文献类型：
--
作者：
Messer, Simon;Cernic, Sendi;Large, Stephen R.
背景：为了应对英国日益增长的心脏移植需求，我们于2015年建立了循环决定死亡(DCD)捐赠者心脏移植的临床计划。5年后，我们报告该计划的临床早期结果和影响。方法：这是一项单中心、回顾性、配对、观察性队列研究，比较了2015年3月1日至2020年2月29日期间DCD捐赠者与英国剑桥皇家帕沃斯医院(RPH)脑死亡(DBD)捐赠者的心脏移植结果。DCD心脏采用胸腹联合常温区域灌注法或直接切取灌注法。所有的DBD心脏都是用标准的静态冷藏获得的。主要结果是受者30天和1年的存活。结果：在5年的研究中，DCD心脏捐献使整体心脏移植活动增加了48%(DCD 79例，DBD 164例)。DCD组30天存活率97%，DBD组99%，P=1.00；1年存活率DCD组91%，DBD组89%，P=0.72。在重症监护病房的住院时间(DCD为7天，DBD为6天，p=0.24)或住院时间(DCD为24天，DBD为25天，P=0.84)之间没有差异。结论：与传统的DBD心脏移植相比，DCD心脏捐献使RPH的心脏移植活动增加了48%，而30天或1年的存活率没有差异。DCD心脏捐赠将使能够从心脏移植中受益的患者数量发生巨大变化。(C)2020年提交人(S)。爱思唯尔公司代表国际心肺移植学会出版。
BACKGROUND: In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program.METHODS: This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK). DCD hearts were either retrieved using thoracoabdominal normothermic regional perfusion or the direct procurement and perfusion technique. All DBD hearts were procured using standard cold static storage. The primary outcomes were recipient 30-day and 1-year survival.RESULTS: During the 5-year study, DCD heart donation increased overall heart transplant activity by 48% (79 for DCD and 164 for DBD). There was no difference in survival at 30 days (97% for DCD vs 99% for DBD, p = 1.00) or 1 year (91% for DCD vs 89% for DBD, p = 0.72). There was no difference in the length of stay in the intensive care unit (7 for DCD vs 6 for DBD days, p = 0.24) or in the hospital (24 for DCD vs 25 for DBD days, p = 0.84).CONCLUSIONS: DCD heart donation increased overall heart transplant activity at RPH by 48%, with no difference in 30-day or 1-year survival in comparison with conventional DBD heart transplantations. DCD heart donation is set to make a dramatic difference in the number of patients who can benefit from heart transplantation. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.