Does cardiopulmonary resuscitation before donor death affect solid organ transplant function? A systematic review and meta-analysis

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation Pub Date : 2025-05-21 DOI:10.1016/j.resuscitation.2025.110654

Claudio Sandroni , Tommaso Scquizzato , Sofia Cacciola , Matteo Aldo Bonizzoni , Stephen West , Sonia D’Arrigo , Jasmeet Soar , International Liaison Committee on Resuscitation ILCOR Advanced Life Support Task Force

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引用次数: 0

Abstract

Introduction

Patients who die after cardiopulmonary resuscitation (CPR) are an important source of solid organs, but ischaemia–reperfusion injury may lead to worse recipient outcomes. This systematic review and meta-analysis assessed if solid organs transplanted from donors who underwent CPR had worse outcomes compared to organs from donors who did not receive CPR.

Methods

PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched until January 1, 2025. The primary outcome (graft survival at the longest follow-up) and secondary outcomes (30-day and 1-year graft survival) were calculated separately for each organ and pathway (brain/circulatory death).

Results

We included 33 studies (26 in adults; 72,994 donors), of which three compared multiple organs and pathways. In 24 studies comparing brain-dead donors with vs without CPR in all organs, outcomes did not differ between groups. In nine studies, donation after uncontrolled circulatory death compared to donation after brain death showed a lower long-term survival for livers (OR 0.51 [0.32–0.83]) and lower short-term but not long-term survival (OR 0.64[0.36–1.15]) for kidneys. Two studies in kidneys compared donation in controlled vs uncontrolled circulatory death showing no different long-term survival (OR 0.73[0.27–1.99]).

Conclusions

Organs transplanted from donors who received CPR demonstrated comparable outcomes at the longest follow-up compared to organs from donors who did not receive CPR. Kidneys and livers after uncontrolled donation after circulatory death showed worse outcomes compared to donation after brain death.

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供体死亡前心肺复苏是否影响实体器官移植功能？系统回顾和荟萃分析。

心肺复苏（CPR）后死亡的患者是实体器官的重要来源，但缺血-再灌注损伤可能导致更差的受者预后。本系统综述和荟萃分析评估了接受心肺复苏术的捐赠者的实体器官移植是否比未接受心肺复苏术的捐赠者的器官移植有更差的结果。方法：检索PubMed、Embase和Cochrane Central Register of Controlled Trials，直到2025年1月1日。对每个器官和途径（脑/循环死亡）分别计算主要结局（最长随访时的移植物存活）和次要结局（30天和1年移植物存活）。结果：我们纳入了33项研究(26项成人研究；72994名捐赠者)，其中3名比较了多个器官和途径。在24项对脑死亡供体进行心肺复苏术与不进行心肺复苏术的研究中，两组之间的结果没有差异。在9项研究中，与脑死亡后的捐赠相比，不受控制的循环死亡后的捐赠显示肝脏的长期生存率较低（OR为0.51[0.32-0.83]），肾脏的短期生存率较低（OR为0.64[0.36-1.15]）。两项肾脏研究比较了控制与不控制循环死亡患者的肾脏捐献，结果显示长期生存率无差异（OR 0.73[0.27-1.99]）。结论：与未接受心肺复苏术的供者相比，接受心肺复苏术的供者移植的器官在最长的随访中显示出相似的结果。与脑死亡后捐献肾脏和肝脏相比，循环死亡后无控制捐献肾脏和肝脏的结果更差。

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

Resuscitation 医学-急救医学

CiteScore

12.00

自引率

18.50%

发文量

556

审稿时长

21 days

期刊介绍： Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.