Severe primary graft dysfunction in heart transplant recipients using donor hearts after circulatory death: United States experience.

IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Peter D Cho, Samuel T Kim, Hedwig Zappacosta, John P White, Stephanie McKay, Reshma Biniwale, Abbas Ardehali
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引用次数: 0

Abstract

Objective: This study compares the incidence of severe Primary Graft Dysfunction (PGD) in a contemporaneous cohort of donors after circulatory death (DCD) and brain death (DBD) heart transplant recipients.

Method: The United Network for Organ Sharing database was queried for isolated adult heart transplant recipients from 9/2023 to 6/2024. Heart recipients were stratified based on the organ donation type (DCD vs DBD). DCD heart recipients were further categorized based on the procurement method: time between circulatory death to cross-clamp: ≤ 30 minutes (Direct Procurement and Preservation, DPP), >30 minutes (Normothermic Regional Perfusion, NRP). Outcomes of interest included: severe PGD (Left/Bi-Ventricular; LV/BiV) at 24 hours and Severe Graft Dysfunction at 72 hours (patients with severe PGD at 24 hours that remain on mechanical support at 72 hours).

Results: A total of 2590 adult heart transplant recipients were identified, of which 17.1% underwent DCD heart transplantation. DCD heart recipients were less likely to be on inotrope (36.7% vs 41.6%, p=0.046) and ECMO (4.1% vs 9.9%, p<0.001) prior to transplant than DBD heart recipients. DCD heart recipients were more likely than DBD heart recipients to develop severe PGD (LV/BiV) at 24 hours (9.5% vs 5.1%, p<0.001). The Severe Graft Dysfunction at 72 hours (2.3% vs 2.9%, p=0.67) and 30-day mortality were similar between the 2 groups. Recipients of DCD heart procured with DPP or NRP had similar severe PGD (LV/BiV) at 24 hours (9.4% vs 9.7%, p=0.93).

Conclusion: Severe PGD at 24 hours is higher among the DCD than DBD heart recipients, but Graft Dysfunction improves by 72 hours.

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来源期刊
CiteScore
10.10
自引率
6.70%
发文量
1667
审稿时长
69 days
期刊介绍: The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.
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