Increasing Multiorgan Heart Transplantations From Donation After Circulatory Death Donors in the United States

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-08-22 DOI:10.1111/ctr.15423

Shivank Madan, Jill Teitelbaum, Omar Saeed, Vagish Hemmige, Sasha Vukelic, Yogita Rochlani, Sandhya Murthy, Daniel B. Sims, Jooyoung Shin, Stephen J. Forest, Daniel J. Goldstein, Snehal R. Patel, Ulrich P. Jorde

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Abstract

Introduction

Donation after circulatory death (DCD) donors are becoming an important source of organs for heart-transplantation (HT), but there are limited data regarding their use in multiorgan-HT.

Methods

Between January 2020 and June 2023, we identified 87 adult multiorgan-HTs performed using DCD-donors [77 heart–kidney, 6 heart–lung, 4 heart–liver] and 1494 multiorgan-HTs using donation after brain death (DBD) donors (1141 heart–kidney, 165 heart–lung, 188 heart–liver) in UNOS. For heart–kidney transplantations (the most common multiorgan-HT combination from DCD-donors), we also compared donor/recipient characteristics, and early outcomes, including 6-month mortality using Kaplan–Meier (KM) and Cox hazards-ratio (Cox-HR).

Results

Use of DCD-donors for multiorgan-HTs in the United States increased from 1% in January to June 2020 to 12% in January–June 2023 (p < 0.001); but there was a wide variation across UNOS regions and center volumes. Compared to recipients of DBD heart–kidney transplantations, recipients of DCD heart–kidney transplantations were less likely to be of UNOS Status 1/2 at transplant (35.06% vs. 69.59%) and had lower inotrope use (22.08% vs. 43.30%), lower IABP use (2.60% vs. 26.29%), but higher durable CF-LVAD use (19.48% vs. 12.97%), all p < 0.01. Compared to DBD-donors, DCD-donors used for heart–kidney transplantations were younger [28(22–34) vs. 32(25–39) years, p = 0.004]. Recipients of heart–kidney transplantations from DCD-donors and DBD-donors had similar 6-month survival using both KM analysis, and unadjusted and adjusted Cox-HR models, including in propensity matched cohorts. Rates of PGF and in-hospital outcomes were also similar.

Conclusions

Use of DCD-donors for multiorgan-HTs has increased rapidly in the United States and early outcomes of DCD heart–kidney transplantations are promising.

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美国增加循环死亡后捐献者的多器官心脏移植。

导言：循环死亡后捐献（DCD）供体正成为心脏移植（HT）的重要器官来源，但有关其在多器官HT中使用的数据有限：方法：2020 年 1 月至 2023 年 6 月期间，我们在 UNOS 上发现了 87 例使用 DCD 供体（77 例心肾、6 例心肺、4 例心肝）进行的成人多器官器官移植，以及 1494 例使用脑死亡后捐献（DBD）供体（1141 例心肾、165 例心肺、188 例心肝）进行的多器官器官移植。对于心肾移植（DCD供体最常见的多器官-HT组合），我们还比较了供体/受体特征以及早期结果，包括使用Kaplan-Meier（KM）和Cox危险比（Cox-HR）计算的6个月死亡率：结果：在美国，使用DCD供体进行多器官肝移植的比例从2020年1月至6月的1%上升到2023年1月至6月的12%（p < 0.001）；但不同UNOS地区和中心数量之间的差异很大。与 DBD 心肾移植受者相比，DCD 心肾移植受者在移植时处于 UNOS 状态 1/2 的可能性较低（35.06% vs. 69.59%），使用肌力药物的比例较低（22.08% vs. 43.30%），使用 IABP 的比例较低（2.60% vs. 26.29%），但使用 CF-LVAD 的持久性较高（19.48% vs. 12.97%），所有数据均 p <0.01。与DBD供体相比，用于心肾移植的DCD供体更年轻[28（22-34）岁 vs. 32（25-39）岁，P = 0.004]。通过KM分析以及未经调整和调整的Cox-HR模型（包括倾向匹配队列），DCD供体和DBD供体的心肾移植受者的6个月存活率相似。PGF率和住院结果也相似：结论：在美国，使用DCD供体进行多器官心肾移植的人数迅速增加，DCD心肾移植的早期结果令人鼓舞。

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来源期刊

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.