Outcomes of Donation After Circulatory Death Heart Transplantation Using Normothermic Regional Perfusion

Annals of thoracic surgery short reports Pub Date : 2025-03-01 DOI:10.1016/j.atssr.2024.09.016

Akshay Kumar MD , Amit Alam MD , Michael Dorsey MD , Les James MD, MPH , Syed Hussain MD , Bernard Kadosh MD , Randal Goldberg MD , Alex Reyentovich MD , Nader Moazami MD , Deane Smith MD

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Abstract

Background

Donation after circulatory death (DCD) with cardiopulmonary bypass for thoracoabdominal normothermic regional perfusion (TA-NRP) has led to increased use of donor hearts. Rejection rates and long-term survival outcomes are not known.

Methods

A single-center retrospective cohort review of patients who underwent DCD heart transplantation from January 2020 to December 2023 was performed. Donor and recipient characteristics, operative characteristics, and posttransplantation outcomes were analyzed. Subgroup analysis comparing co-localized vs distant donors and recipients was performed. The primary end point was 1-year survival. Secondary end points included incidences of primary graft dysfunction (PGD), cardiac allograft vasculopathy (CAV), rejection rate, and overall mortality. Our TA-NRP protocol has remained the same, consisting of sternotomy, ligation of aortic arch vessels, establishment of cardiopulmonary bypass, reintubation, resuscitation of the heart, and cold static storage during transport.

Results

In total, 32 recipients underwent DCD heart transplantation, including 26 isolated hearts, 3 heart-lungs, and 3 heart-kidneys. The median age was 56 years for recipients and 39 years for donors; 21 donors and recipients were co-localized, whereas 11 were distant. One-year survival was 100%. Two patients required mechanical circulatory support for PGD. Four patients experienced grade 2R acute cellular rejection. Five patients had grade 1 CAV at 1 year. On subgroup analysis, distant donors and recipients had longer warm (47 vs 30 minutes; P < .005) and cold (213 vs 76 minutes; P < .005) ischemia times, without any other differences.

Conclusions

Outcomes after DCD heart transplantation using TA-NRP remain encouraging with acceptable rates of rejection, PGD, CAV, and survival at 1 year.

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常温区域灌注循环死亡心脏移植后捐献的结果

背景：循环死亡（DCD）后的体外循环（TA-NRP）捐献导致供体心脏的使用增加。排异率和长期生存结果尚不清楚。方法对2020年1月至2023年12月接受DCD心脏移植的患者进行单中心回顾性队列分析。分析供体和受体特征、手术特征和移植后结果。进行亚组分析，比较共定位与异地供者和受者。主要终点为1年生存率。次要终点包括原发性移植物功能障碍（PGD）、心脏异体移植物血管病变（CAV）、排异率和总死亡率。我们的TA-NRP方案保持不变，包括胸骨切开，主动脉弓血管结扎，建立体外循环，重新插管，心脏复苏，以及运输过程中的冷静态储存。结果32例患者行DCD心脏移植，其中离体心脏26颗，心脏-肺3颗，心脏-肾3颗。受者的中位年龄为56岁，供者的中位年龄为39岁；21个捐赠者和受赠人是同地的，11个是异地的。一年生存率为100%。2例患者需要机械循环支持进行PGD。4例患者出现2R级急性细胞排斥反应。5例患者1年时为1级CAV。在亚组分析中，远距离供体和受体的温暖时间更长(47分钟vs 30分钟；P & lt;0.005)和冷(213 vs 76分钟；P & lt;.005)缺血时间，无其他差异。结论：采用TA-NRP进行DCD心脏移植后的结果仍然令人鼓舞，排异率、PGD、CAV和1年生存率均可接受。

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

Annals of thoracic surgery short reports Surgery

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审稿时长

53 days