Successful clinical transplantation of hearts donated after circulatory death using normothermic regional perfusion
Successful clinical transplantation of hearts donated after circulatory death using normothermic regional perfusion
复制标题
DOI：
10.1016/j.healun.2019.02.015
复制
发表时间：
2019-06-01
影响因子：
8.9
通讯作者：
Defraigne, Jean Olivier
中科院分区：
文献类型：
--
作者：
Tchana-Sato, Vincent;Ledoux, Didier;Defraigne, Jean Olivier
背景技术背景：循环死亡（DCD）后供体心脏移植（HT）虽取得了可喜的效果，但尚未获得广泛的临床应用。在这项研究中，我们描述了2例成功的成人DCD HT在我们的机构使用原始protocol.METHODS：我们的本地腹部DCD协议进行了更新，允许DCD心脏采购，并接受了机构伦理委员会。该方案的主要特征包括：在死前插入外周静脉动脉体外膜氧合插管;通过夹闭3条主动脉弓血管进行胸腹常温区域灌注（NRP）以排除脑循环;以及原位心脏复苏。结果：第1例供体获得热缺血时间为25 min，第2例供体获得热缺血时间为26 min。第一个受体的冷缺血时间为16分钟，第二个受体为17分钟。第一个受体的缝合时间为30分钟，第二个受体为53分钟。在窦性心律和正性肌力支持下，两例受者都很容易脱离体外循环。心脏功能的术后评价是优秀的，患者随后出院home.CONCLUSIONS：心脏移植从DCD捐助者现在是一个临床现实。NRP是移植心脏复苏、再灌注和保存的有用工具。它还提供了在移植前评估器官功能和活力的机会。然而，由于伦理问题，有些人可能会反对死前干预。(C)2019年国际心肺移植学会。All rights reserved.
BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol.METHODS: Our local abdominal DCD protocol was updated to allow DCD heart procurement, and was accepted by the institutional ethics committee. The main features of the protocol include: pre-mortem insertion of peripheral venoarterial extracorporeal membrane oxygenation cannulas; thoracoabdominal normothermic regional perfusion (NRP) by clamping the 3 aortic arch vessels to exclude cerebral circulation; and in-situ heart resuscitation. The retrieved hearts were directly transplanted into recipients located in an adjoining operating room.RESULTS: The procurement warm ischemic time was 25 minutes for the first donor, and 26 minutes for the second donor. The cold ischemic time was 16 minutes for the first recipient and 17 minutes for the second recipient. The suture time was 30 minutes for the first recipient, and 53 minutes for the second recipient. Both recipients were easily weaned off cardiopulmonary bypass in sinus rhythm and inotropic support. Post-operative evaluation of cardiac function was excellent and the patients were subsequently discharged home.CONCLUSIONS: Transplantation of hearts from DCD donors is now a clinical reality. NRP is a useful tool for resuscitation, reperfusion, and preservation of transplanted hearts. It also offers the opportunity to assess the function and viability of organs before transplantation. However, due to ethical issues, some may object to ante-mortem intervention. (C) 2019 International Society for Heart and Lung Transplantation. All rights reserved.