Simultaneous Heart and Kidney Transplantation utilizing Circulatory Death Donors in the United States

medRxiv - Cardiovascular Medicine Pub Date : 2024-08-20 DOI:10.1101/2024.08.16.24312145

Sooyun Caroline Tavolacci, Kenji Okumura, Ameesh Isath, Gabriel Rodriguez, Corazon Belisario De La Pena, Junichi Shimamura, Steven L Lansman, Suguru Ohira

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Abstract

Objective: Heart transplants utilizing donors from circulatory death (DCD) allografts are rapidly growing with the potential to expand the donor pool. However, little is known about the use of DCD donors for simultaneous heart and kidney transplants (SHKT) compared to SHKT using brain death donors (DBD). Methods: From May 22, 2020, to September 30, 2023, 1,129 adult patients received SHKT (DCD, N=91 vs. DBD, N=1,038), identified using the United Network for Organ Sharing database, excluding other multi-organ transplants and re-transplants. A 1:3 ratio propensity score matching was performed using 17 recipient characteristics and 7 donor characteristics. A total of 91 DCD and 273 DBD matched cases were compared. Results: In the unmatched cohort, DCD recipients were older (DCD: 60 vs. DBD: 58 years, p=0.03) and had a lower rate of dialysis at transplant (27% vs. 40%, p=0.03) and status 1 to 2 patients (43% vs. 72%, p<.001). Donors were younger (30 vs. 32 years, p=0.02) in the DCD group. In the matched cohort, kidney delayed graft function (27% vs. 22%, p=0.29) was comparable, as were recipient survival (p=0.19), heart graft survival (p=0.19), and kidney graft survival (p=0.17). In multivariate Cox proportional hazards analysis, donor type (DCD) was not associated with an increased risk of mortality (HR=1.69, 95% Cl 0.90-3.16, p=0.10). Sub-group analysis showed that survival and freedom from graft failures were comparable between different modes of DCD recovery. The centers performing both DCD- and DBD-SHKT showed significantly shorter waitlist days with comparable transplant outcomes compared to centers that only performed DBD-SHKT. Conclusions: SHKT using DCD donors yields comparable survival and graft outcomes to those using DBD donors. These findings will guide treatment strategies for heart transplant candidates with kidney dysfunction, including the selection of donors and patients and safety net policy options.

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美国利用体外循环死亡捐献者同时进行心脏和肾脏移植手术

目的：利用循环死亡（DCD）供体同种异体移植的心脏移植手术正在迅速增加，有可能扩大供体库。然而，与使用脑死亡供体（DBD）进行心脏和肾脏同时移植（SHKT）相比，人们对使用 DCD 供体进行心脏和肾脏同时移植（SHKT）的情况知之甚少。方法：从2020年5月22日至2023年9月30日，1129名成年患者接受了SHKT（DCD，N=91 vs. DBD，N=1,038），这些患者是通过器官共享联合网络数据库确定的，不包括其他多器官移植和再移植。使用 17 个受者特征和 7 个供者特征进行了 1:3 比例倾向得分匹配。共比较了 91 例 DCD 和 273 例 DBD 匹配病例。结果：在非匹配队列中，DCD 受者年龄较大（DCD：60 岁 vs. DBD：58 岁，p=0.03），移植时透析率较低（27% vs. 40%，p=0.03），状态 1 至 2 的患者比例较低（43% vs. 72%，p<.001）。DCD组的捐献者更年轻（30岁对32岁，P=0.02）。在配对队列中，肾脏延迟移植物功能（27% 对 22%，P=0.29）与受者存活率（P=0.19）、心脏移植物存活率（P=0.19）和肾脏移植物存活率（P=0.17）相当。在多变量考克斯比例危险分析中，供体类型（DCD）与死亡率风险增加无关（HR=1.69，95% Cl 0.90-3.16，P=0.10）。分组分析表明，不同的 DCD 恢复模式的存活率和移植物失败率相当。与只进行DBD-SHKT的中心相比，同时进行DCD-SHKT和DBD-SHKT的中心的等待天数明显较短，移植结果也相当。结论：使用DCD供体的SHKT与使用DBD供体的SHKT可获得相当的存活率和移植结果。这些发现将指导肾功能不全心脏移植候选者的治疗策略，包括供体和患者的选择以及安全网政策选择。

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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medRxiv - Cardiovascular Medicine

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