循环性死亡心脏移植后捐献患者的等候名单结果优越

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2025-06-16 DOI:10.1016/j.jchf.2025.03.039

Max Shin MD , Omar Toubat MD, PhD , Michael A. Catalano MD , Amit Iyengar MD, MSE , Mark R. Helmers MD , Michaela Asher BS , David Rekhtman BS , Cindy Song BA , Mauer Biscotti MD , Marisa Cevasco MD, MPH

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引用次数: 0

摘要

背景心脏获取技术的最新进展促进了循环性死亡后获得的心脏的利用。然而，要辨别最受益的人群，需要了解候补名单的结果。本研究的目的是评估美国循环死亡（DCD）心脏捐献患者的等待名单和移植后的结果，按名单状态分层。方法查询2018年10月至2024年6月间等待离体心脏移植的所有成人患者的UNOS （United Network for Organ Sharing）数据库。根据脑死亡后和DCD后心脏捐赠的批准对患者进行分层。DCD患者被细分为在名单上或在等待名单期间的DCD候选人。等待名单和移植后的结果比较使用Fine &；Gray和Kaplan-Meier分析。结果共发现24,970例患者；其中，8191人（33%）被列为DCD候选人。DCD状态2、3、4和6的患者更有可能被移植，而在等待名单上死亡的可能性更小。两组移植后生存率均无差异。接受DCD心脏并不能预测死亡率。最初被列为DCD候选人的患者比后来在等待名单过程中成为DCD候选人的患者更有可能进行移植。结论：除状态1外，等待DCD心脏的患者等待时间更短，移植率更高，与脑死亡受者捐赠后的长期生存率相当。

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Superior Waitlist Outcomes Among Patients Listed for Donation After Circulatory Death Heart Transplantation

Background

Recent advances in heart procurement techniques have facilitated the utilization of hearts obtained after circulatory death. However, discerning the population that stands to benefit most requires an understanding of waitlist outcomes.

Objectives

The objective of this study was to evaluate waitlist and post-transplant outcomes among patients listed for donation after circulatory death (DCD) hearts in the United States, stratified by listing status.

Methods

The UNOS (United Network for Organ Sharing) database was queried for all adult patients waitlisted for isolated heart transplantation between October 2018 and June 2024. Patients were stratified by approval for donation after brain death vs DCD hearts. DCD patients were subdivided into those who were DCD candidates at time of listing or later during their waitlist period. Waitlist and post-transplant outcomes were compared using Fine & Gray and Kaplan-Meier analyses.

Results

A total of 24,970 patients were identified; of these, 8,191 (33%) were listed as DCD candidates. DCD status 2, 3, 4, and 6 patients were more likely to be transplanted and less likely to die on the waitlist. There were no differences in post-transplant survival in any group. Receipt of a DCD heart was not predictive of mortality. Patients initially listed as DCD candidates were significantly more likely to be transplanted than those who became DCD candidates later during their waitlist course.

Conclusions

With exception of status 1, patients waitlisted for DCD hearts experience shorter waitlist duration, improved rates of transplantation, and comparable long-term survival with donation after brain death recipients.

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.