Donation after Circulatory Death Does Not Worsen Survival after Heart Transplant for Patients with a Durable Left Ventricular Assist Device

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Erin M. Schumer, Kukbin Choi, Doug A. Gouchoe, Divyaam Satija, Andrew N. Rosenbaum, Sudhir Kushwaha, Atta Behfar, Mauricio A. Villavicencio, Philip J. Spencer
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Abstract

Heart transplantation from donors after circulatory death (DCD) has demonstrated increased primary graft dysfunction. Durable mechanical circulatory (MCS) recipients have slightly higher perioperative risk but excellent long-term survival. We sought to determine if the use of DCD donors impacted outcomes for patients with MCS. The United Network for Organ Sharing database was queried from 2019 to 2023 for all adult recipients who underwent heart transplant with a durable left ventricular assist device (LVAD). Outcomes were compared for recipients of DBD and DCD donors. Kaplan–Meier analysis was used to compare survival. A total of 3449 recipients underwent heart transplant who met the study criteria. The number of DCD and DBD donors was 288 (8.4%) and 3161 (92.6%). There was no difference in the length of stay, postoperative dialysis, pacemaker, stroke rate, or in-hospital mortality. Recipients with durable LVADs of DCD donors had a higher rate of treatment for rejection within the first year. Overall survival was not different between DBD and DCD donors (p = 0.153). Postoperative and survival outcomes for DCD donation remain similar between patients with and without MCS. These findings may help decrease waitlist time for patients with durable MCS.

Abstract Image

循环性死亡后捐献不会恶化装有耐用左心室辅助装置的患者心脏移植后的存活率
循环死亡(DCD)后捐献者的心脏移植显示原发性移植物功能障碍增加。持久机械循环(MCS)受者的围手术期风险稍高,但长期存活率极佳。我们试图确定使用 DCD 供体是否会影响 MCS 患者的预后。我们查询了器官共享联合网络(United Network for Organ Sharing)数据库2019年至2023年期间所有使用耐用左心室辅助装置(LVAD)进行心脏移植的成年受者。对DBD和DCD供体的受者的结果进行了比较。采用 Kaplan-Meier 分析比较存活率。共有 3449 名符合研究标准的受者接受了心脏移植手术。DCD和DBD供体的数量分别为288例(8.4%)和3161例(92.6%)。在住院时间、术后透析、起搏器、中风率和院内死亡率方面没有差异。DCD捐献者的耐用LVAD受者在第一年内接受排斥治疗的比例较高。DBD 和 DCD 供体的总体存活率没有差异(p = 0.153)。DCD捐献的术后和存活结果在患有和不患有MCS的患者之间仍然相似。这些发现可能有助于减少耐久性 MCS 患者的等待时间。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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