Lorenzo D'Angelo, Christiana Gjelaj, Enklajd Marsela, Julio A. Ovalle-Ramos, Carles Díez-López, Kalil Salkey, Marie Galvao, Jeanne Hickey, Yogita Rochlani, Sandhya Murthy, Shivank Madan, Daniel B. Sims, Julia J. Shin, Daniel J. Goldstein, Stephen J. Forest, Snehal R. Patel, Ulrich P. Jorde, Omar Saeed
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引用次数: 0
Abstract
Background
Heart transplantation (HT) following donation after circulatory death (DCD) has grown substantially in recent years. However, the effects of functional ischemic injury during procurement on exercise capacity remain unknown. We compared exercise performance parameters between DCD and donation after brain death (DBD) recipients.
Methods
We conducted a single-center, retrospective, case–control study of adults with isolated HT between January 2022 and April 2024 and completed a treadmill cardiopulmonary exercise test (CPET) post-transplant. DCD-HT recipients (cases) were matched to DBD-HT recipients (controls) based on major demographics and CPET timing. The primary outcome was peak oxygen consumption (pVO2). Secondary outcomes included additional exercise capacity parameters and echocardiographic indices at peak exercise.
Results
Cases (DCD-HT: n = 10, 20% female) and controls (DBD-HT: n = 10, 20% female) had similar baseline characteristics. Total ischemic time was longer in the DCD group (6.9 [interquartile range (IQR): 6.4–7.1] vs. 4.6 [IQR: 3.94.8] h; p = 0.002). Time from HT to CPET did not differ. DCD and DBD-HT recipients had similar pVO2 (17.1 [IQR: 15.2–19.7] vs. 19.7 [IQR: 13.3–21.2] mL/kg/min; p = 0.545). Respiratory exchange ratio (RER) was slightly lower in the DCD group (1.1 [IQR: 1.0–1.2] vs. 1.2 [IQR: 1.21.3]; p = 0.031). Ventilatory efficiency (VE/VCO2) at anaerobic threshold, left ventricular ejection fraction, and E/e′ at peak exercise were comparable between groups.
Conclusion
DCD and DBD heart transplant recipients demonstrate similar exercise performance. Overall, exercise capacity remains limited after HT, highlighting the need for further studies to identify underlying mechanisms and potential therapeutic interventions.
期刊介绍:
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.