循环死亡和脑死亡后捐献心脏移植受者的运动表现

IF 1.9 4区 医学 Q2 SURGERY
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

摘要

背景:近年来,循环性死亡(DCD)捐赠后的心脏移植(HT)有了显著增长。然而,获取过程中功能性缺血性损伤对运动能力的影响尚不清楚。我们比较了DCD和脑死亡后捐赠(DBD)受者的运动表现参数。方法:我们对2022年1月至2024年4月期间患有孤立性HT的成人进行了一项单中心、回顾性、病例对照研究,并在移植后完成了跑步机心肺运动试验(CPET)。根据主要人口统计数据和CPET时间,将DCD-HT受体(病例)与DBD-HT受体(对照组)进行匹配。主要终点是峰值耗氧量(pVO2)。次要结果包括额外的运动能力参数和峰值运动时的超声心动图指数。结果病例(ddd - ht: n = 10,女性占20%)与对照组(DBD-HT: n = 10,女性占20%)基线特征相似。DCD组总缺血时间更长(6.9[四分位数间距(IQR): 6.4-7.1]比4.6 [IQR: 3.94.8] h;P = 0.002)。从HT到CPET的时间没有差异。DCD和DBD-HT患者的pVO2相似(17.1 [IQR: 15.2-19.7] vs. 19.7 [IQR: 13.3-21.2] mL/kg/min; p = 0.545)。DCD组呼吸交换比(RER)略低(1.1 [IQR: 1.0-1.2] vs. 1.2 [IQR: 1.21.3]; p = 0.031)。两组无氧阈时的通气效率(VE/VCO2)、左心室射血分数和运动峰值时的E/ E′具有可比性。结论DCD和DBD心脏移植受者具有相似的运动表现。总的来说,HT后的运动能力仍然有限,强调需要进一步研究以确定潜在的机制和潜在的治疗干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exercise Performance in Transplant Recipients of Hearts From Donation After Circulatory Death and Donation After Brain Death

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.

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来源期刊
Clinical Transplantation
Clinical Transplantation 医学-外科
CiteScore
3.70
自引率
4.80%
发文量
286
审稿时长
2 months
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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