Nayeem Nasher, Daler Rahimov, T. Reese Macmillan, Faizaan Siddique, J. Eduardo Rame, Howard J. Eisen, Rene J. Alvarez, Keshava Rajagopal, John W. Entwistle, Vakhtang Tchantchaleishvili
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Transplantation rates, along with associated factors, were assessed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The rate of heart allograft utilization was 6.9% in DCD donors compared to 35.4% among DBD donors (<i>p</i> < 0.001). Subgroup analysis of ideal donors demonstrated that 41% of DCD donors were utilized for heart transplantation compared to 85% of DBD donors (<i>p</i> < 0.001). Multivariable logistic regression analysis for heart utilization demonstrated that interventions, including extracorporeal life support (odds ratio [OR] 7.48, 95% CI 4.72–12.35) and coronary angiography (OR 2.77, 95% CI 1.76–4.39), were independent predictors of utilization. There was no significant association with hypertension (OR 0.75, 95% CI 0.52–1.06), tobacco use (OR 0.71, 95% CI 0.47–1.06), or BMI (OR 0.99, 95% CI 0.97–1.01) in the ideal DCD donor. 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引用次数: 0
摘要
背景循环死亡（DCD）后捐赠的同种异体心脏移植数量仍然很低，特别是与脑死亡（DBD）后捐赠的心脏移植相比。我们的研究旨在确定与理想供体心脏利用率不足相关的因素。方法从联合器官共享网络（UNOS）数据库中获取2020年1月至2023年12月期间接受器官获取和随后移植的所有成年死亡供体的患者水平数据。“理想”DCD供者作为一个单独的子集进行分析，并与理想DBD供者进行比较。评估移植率及相关因素。结果DCD供者心脏异体移植使用率为6.9%，而DBD供者为35.4% （p < 0.001）。理想供者的亚组分析表明，41%的DCD供者被用于心脏移植，而DBD供者的这一比例为85% （p < 0.001）。心脏利用的多变量logistic回归分析表明，包括体外生命支持（比值比[OR] 7.48, 95% CI 4.72-12.35）和冠状动脉造影（比值比[OR] 2.77, 95% CI 1.76-4.39）在内的干预措施是心脏利用的独立预测因子。理想的DCD供者与高血压（OR 0.75, 95% CI 0.52-1.06）、吸烟（OR 0.71, 95% CI 0.47-1.06）或BMI （OR 0.99, 95% CI 0.97-1.01）无显著相关性。观察供体心脏使用率的区域差异。结论仍有相当一部分理想的DCD供者心脏未得到利用。识别和处理与器官利用不足有关的因素可以提高器官产量。
Heart Allograft Utilization Rates Following Donation After Circulatory Death Compared to Donation After Brain Death in the Ideal Heart Donor
Background
The number of heart allografts obtained from donation after circulatory death (DCD) remains low, especially compared to donation after brain death (DBD). Our study aimed to identify factors associated with the underutilization of hearts in ideal donors.
Methods
Patient-level data were obtained from the United Network for Organ Sharing (UNOS) database for all adult deceased donors who underwent organ procurement and subsequent transplantation between January 2020 and December 2023. “Ideal” DCD donors were analyzed as a separate subset and compared with ideal DBD donors. Transplantation rates, along with associated factors, were assessed.
Results
The rate of heart allograft utilization was 6.9% in DCD donors compared to 35.4% among DBD donors (p < 0.001). Subgroup analysis of ideal donors demonstrated that 41% of DCD donors were utilized for heart transplantation compared to 85% of DBD donors (p < 0.001). Multivariable logistic regression analysis for heart utilization demonstrated that interventions, including extracorporeal life support (odds ratio [OR] 7.48, 95% CI 4.72–12.35) and coronary angiography (OR 2.77, 95% CI 1.76–4.39), were independent predictors of utilization. There was no significant association with hypertension (OR 0.75, 95% CI 0.52–1.06), tobacco use (OR 0.71, 95% CI 0.47–1.06), or BMI (OR 0.99, 95% CI 0.97–1.01) in the ideal DCD donor. Regional variation in donor heart utilization rates was observed.
Conclusion
There remains a significant portion of ideal DCD donors whose hearts remain unutilized. Identifying and addressing factors related to underutilization may improve organ yield.
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.
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