Early U.S. Heart Transplant Experience With Normothermic Regional Perfusion Following Donation After Circulatory Death

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2024-12-01 DOI:10.1016/j.jchf.2024.06.007

Abigail R. Benkert MD , Jeffrey E. Keenan MD , Jacob N. Schroder MD , Adam D. DeVore MD, MHS , Chetan B. Patel MD , Carmelo A. Milano MD , Oliver K. Jawitz MD, MHS

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引用次数: 0

Abstract

Background

Heart transplantation following donation after circulatory death (DCD HT) has short-term survival outcomes comparable to donation after brain death and has led to a significant increase in transplantation volume. The U.S. experience with the normothermic regional perfusion (NRP) DCD HT procurement method has not been evaluated.

Objectives

The aim of this study was to examine short-term outcomes associated with NRP vs direct procurement and perfusion (DPP) methods used during DCD HT in the United States.

Methods

The UNOS (United Network for Organ Sharing) registry was queried for all adult (age ≥18 years) heart recipients and corresponding donors of controlled DCD HT from January 2019-December 2023. Transplantations were stratified by NRP or DPP reperfusion methods. The primary outcome was overall survival.

Results

A total of 918 heart donors and recipients met inclusion criteria, including 622 (68%) DPP and 296 (32%) NRP transplantations. Unadjusted Kaplan-Meier survival analysis demonstrated improved short-term survival associated with NRP (log-rank P = 0.005). After adjustment, DCD HT with NRP was independently associated with improved survival (HR: 0.39 [95% CI: 0.22-0.70]; P = 0.002). A propensity-matched analysis similarly demonstrated a cumulative survival benefit to NRP (log-rank P = 0.006).

Conclusions

In this largest national series of DCD HT procurement perfusion strategies, NRP is associated with improved short-term survival as compared with DPP. This study evaluates the U.S. early experience with DCD HT, and longer-term follow-up data are needed to further assess the impact of DPP and NRP methods on post-heart transplantation outcomes.

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美国早期心脏移植经验：循环死亡后捐献的常温区域灌注。

背景：循环死亡后捐献（DCD HT）心脏移植的短期存活率与脑死亡后捐献的存活率相当，并使移植量显著增加。美国采用常温区域灌注（NRP）DCD HT 采集方法的经验尚未得到评估：本研究旨在考察美国 DCD HT 过程中使用的常温区域灌注（NRP）与直接获取和灌注（DPP）方法的短期效果：方法：在 UNOS（器官共享联合网络）登记处查询了 2019 年 1 月至 2023 年 12 月期间所有成人（年龄≥18 岁）心脏受者和相应的受控 DCD HT 供体。移植手术按 NRP 或 DPP 再灌注方法进行分层。主要结果为总生存率：共有918名心脏捐献者和受者符合纳入标准，其中包括622例（68%）DPP移植和296例（32%）NRP移植。未经调整的 Kaplan-Meier 生存分析表明，NRP 可提高短期生存率（对数秩 P = 0.005）。经过调整后，DCD HT 与 NRP 单独与生存率的提高相关（HR：0.39 [95% CI：0.22-0.70]；P = 0.002）。倾向匹配分析同样显示了NRP的累积生存获益（log-rank P = 0.006）：结论：在这项规模最大的 DCD HT 采购灌注策略全国系列研究中，与 DPP 相比，NRP 与短期生存率的提高有关。这项研究评估了美国 DCD HT 的早期经验，需要更长期的随访数据来进一步评估 DPP 和 NRP 方法对心脏移植术后预后的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.