Taimoor Khan, Stephen Pettit, Muhammad Raza Sarfraz, Mahmoud Hashim, Sri Aurovind, Luis Martinez, Clive Lewis, Anna Kydd, Prashant Mohite, Muhammad Umar Rafiq, Pradeep Kaul, Steven Tsui, David Jenkins, Sai Bhagra, Stephen Large, Marius Berman, Hassiba Smail
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引用次数: 0
Abstract
Background: Functional warm ischemic time (FWIT) is known to affect outcomes after donation after circulatory death (DCD) heart transplantation (HTx), but its definition lacks worldwide consensus. This study examines the impact of FWIT on outcomes in DCD HTx.
Methods: This study included 125 adult DCD HTx recipients retrieved by direct procurement and perfusion (DPP), 2015-2026. FWIT was defined as the interval from donor systolic blood pressure <50 mmHg to reperfusion on ex-situ normothermic machine perfusion. Recipients were stratified by FWIT (≤30 vs >30 minutes). Primary outcomes were severe primary graft dysfunction (PGD) and all-cause mortality, modelled using restricted cubic splines (RCS) and Cox regression.
Results: FWIT was ≤30 minutes in 87 recipients (69.6%) and >30 minutes in 38 (30.4%), median FWIT was 27 minutes (IQR 24-32). Over a median follow-up of 5.4 years, 24 deaths occurred. FWIT was not independently associated with mortality (HR 1.11, 95% CI 0.83-1.46), RCS modelling showed no significant association across the observed range (HR 1.10 at 35 min, HR 1.13 at 40 min, vs. reference of 30 min). There was no significant difference between ≤30 and >30 min groups in survival at 1 year (88.8% vs 84.4%, p=0.75), incidence of severe PGD (23% vs 23.7%, p>0.99), post-transplant mechanical circulatory support (23% vs 31.6%, p=0.31), or long-term survival on Kaplan-Meier analysis (p=0.304).
Conclusions: Prolonged FWIT does not appear to adversely affect HTx outcomes in this cohort. Larger, multicentre studies are needed to define an optimal FWIT threshold and a unified definition worldwide.
背景：已知功能性热缺血时间（FWIT）影响循环死亡（DCD）心脏移植（HTx）捐献后的预后，但其定义缺乏全球共识。本研究探讨了FWIT对DCD HTx预后的影响。方法：本研究纳入2015-2026年125例采用直接采购和灌注（DPP）方法检索的成人DCD HTx受体。FWIT定义为从供体收缩压开始的间隔时间（30分钟）。主要结局是严重的原发性移植物功能障碍（PGD）和全因死亡率，采用限制性三次样条（RCS）和Cox回归建模。结果：87例（69.6%）患者的FWIT≤30分钟，38例（30.4%）患者的FWIT≤30分钟，中位FWIT为27分钟（IQR 24-32）。在平均5.4年的随访中，发生了24例死亡。FWIT与死亡率没有独立关联（风险比1.11,95%可信区间0.83-1.46），RCS模型显示在观察范围内无显著关联（35分钟时风险比1.10,40分钟时风险比1.13，对照30分钟）。Kaplan-Meier分析显示，≤30 min组和≤30 min组在1年生存率（88.8% vs 84.4%, p=0.75）、严重PGD发生率（23% vs 23.7%, p>0.99）、移植后机械循环支持（23% vs 31.6%, p=0.31）或长期生存率（p=0.304）方面无显著差异。结论：在这个队列中，延长的FWIT似乎没有对HTx结果产生不利影响。需要更大的、多中心的研究来确定最佳的FWIT阈值和全球统一的定义。
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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