Background

Given the shortage of suitable donor hearts for cardiac transplantation and the growing interest in donation after circulatory death (DCD), our institution recently began procuring cardiac allografts from DCD donors.

Methods

Between October 2020 and March 2021, 15 patients with heart failure underwent cardiac transplantation using DCD allografts. Allografts were procured using a modified extracorporeal membrane oxygenation circuit for thoracic normothermic regional perfusion (TA-NRP) and were subsequently transported using cold static storage. Data collection and analysis were performed with institutional review board approval.

Results

The mean age of the DCD donors was 23 ± 7 years and average time on TA-NRP was 56 ± 8 minutes. Total ischemic time was 183 ± 31 minutes and distance from transplant center was 373 ± 203 nautical miles. Recipient age was 55 ± 14 years, with 8 (55.3%) recipients on durable left ventricular assist device support. Post-transplant, 6 (40%) recipients experienced mild left ventricle primary graft dysfunction (PGD-LV), 3 (20%) recipients experienced moderate PGD-LV, and no recipients experienced severe PGD-LV. Postoperative transthoracic echocardiogram demonstrated left ventricular ejection fraction >55% in all recipients. One recipient (6.6%) developed International Society for Heart and Lung Transplantation 2R acute cellular rejection on first biopsy. At last follow-up, all 15 recipients were alive past 30-days.

Conclusions

Cardiac DCD provides an opportunity to increase the availability of donor hearts for transplantation. Utilizing TA-NRP with cold static storage, we have extended the cold ischemic time of DCD allografts to almost 3 hours, allowing for inter-hospital organ transport.

中文翻译：

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美国早期使用常温区域灌注进行循环死亡 (DCD) 后心脏捐献的经验

背景

鉴于缺乏适合心脏移植的供体心脏，以及对循环死亡 (DCD) 后捐赠的兴趣日益浓厚，我们机构最近开始从 DCD 供体处采购心脏同种异体移植物。

方法

2020 年 10 月至 2021 年 3 月期间，15 名心力衰竭患者接受了使用 DCD 同种异体移植物的心脏移植。同种异体移植物是使用用于胸部常温区域灌注 (TA-NRP) 的改良体外膜氧合回路获得的，随后使用冷静态储存进行运输。数据收集和分析是在机构审查委员会批准的情况下进行的。

结果

DCD 捐赠者的平均年龄为 23 ± 7 岁，TA-NRP 的平均时间为 56 ± 8 分钟。总缺血时间为 183 ± 31 分钟，距移植中心的距离为 373 ± 203 海里。接受者年龄为 55 ± 14 岁，其中 8 名 (55.3%) 接受者接受持久的左心室辅助装置支持。移植后，6 名 (40%) 受者出现轻度左心室原发性移植物功能障碍 (PGD-LV)，3 名 (20%) 受者出现中度 PGD-LV，没有受者出现严重 PGD-LV。术后经胸超声心动图显示左心室射血分数>55% 在所有收件人中。一名接受者（6.6%）在第一次活检时发展为国际心肺移植学会 2R 急性细胞排斥反应。在最后一次随访中，所有 15 名接受者都存活了 30 天。

结论

心脏 DCD 提供了增加供体心脏进行移植的机会。利用 TA-NRP 和静态冷存储，我们将 DCD 同种异体移植物的冷缺血时间延长至近 3 小时，从而实现医院间器官运输。