Matthew L. Goodwin MD , Ian C. Nickel MD , Hui Li MSTAT, MD , Hiroshi Kagawa MD, PhD , Christos P. Kyriakopoulos MD , Thomas C. Hanff MD , Josef Stehlik MD , Stavros G. Drakos MD, PhD , Craig H. Selzman MD
{"title":"Direct procurement with machine perfusion and normothermic regional perfusion in donation after circulatory death heart transplantation","authors":"Matthew L. Goodwin MD , Ian C. Nickel MD , Hui Li MSTAT, MD , Hiroshi Kagawa MD, PhD , Christos P. Kyriakopoulos MD , Thomas C. Hanff MD , Josef Stehlik MD , Stavros G. Drakos MD, PhD , Craig H. Selzman MD","doi":"10.1016/j.jtcvs.2024.10.033","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Donation after circulatory death (DCD) heart transplants have increased in the United States with direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of the DCD technique on post-transplant outcomes compared to donation after brain death (DBD) donors.</div></div><div><h3>Methods</h3><div>Adult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023, were identified in the United Network for Organ Sharing registry. DPP and TA-NRP groups were identified using time of death to an aortic cross-clamp time of 30 minutes. Categorical variables were compared using the χ<sup>2</sup> or Fisher exact test, and continuous variables were compared using the Mann-Whitney <em>U</em> test. Propensity score matching was performed using a 1:3 match. One-year survival was analyzed using the log-rank test and a Cox proportional hazard regression model.</div></div><div><h3>Results</h3><div>During the study period, there were 7338 DBD and 419 DCD heart transplants. At 1 year post-transplant, there was no difference in survival between unmatched (<em>P</em> = .13) and matched (<em>P</em> = .36) DBD and DCD heart recipients. There was an increase in acute rejection and rejection requiring treatment in DCD recipients compared to DBD recipients in the matched cohort. A total of 134 TA-NRP transplants and 242 DPP transplants were performed. One-year survival and post-transplant outcomes were similar in the DPP and TA-NRP groups. TA-NRP functional warm ischemia time (fWIT) was increased significantly during the study period.</div></div><div><h3>Conclusions</h3><div>In this matched cohort, DCD heart recipients experienced increased acute rejection, both treated and nontreated, compared to DBD heart recipients. Despite differences in the techniques and likely in fWIT, acute rejection, survival, and other secondary outcomes are similar with DPP and TA-NRP.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 1","pages":"Pages 256-265.e6"},"PeriodicalIF":4.4000,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S002252232400984X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Donation after circulatory death (DCD) heart transplants have increased in the United States with direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of the DCD technique on post-transplant outcomes compared to donation after brain death (DBD) donors.
Methods
Adult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023, were identified in the United Network for Organ Sharing registry. DPP and TA-NRP groups were identified using time of death to an aortic cross-clamp time of 30 minutes. Categorical variables were compared using the χ2 or Fisher exact test, and continuous variables were compared using the Mann-Whitney U test. Propensity score matching was performed using a 1:3 match. One-year survival was analyzed using the log-rank test and a Cox proportional hazard regression model.
Results
During the study period, there were 7338 DBD and 419 DCD heart transplants. At 1 year post-transplant, there was no difference in survival between unmatched (P = .13) and matched (P = .36) DBD and DCD heart recipients. There was an increase in acute rejection and rejection requiring treatment in DCD recipients compared to DBD recipients in the matched cohort. A total of 134 TA-NRP transplants and 242 DPP transplants were performed. One-year survival and post-transplant outcomes were similar in the DPP and TA-NRP groups. TA-NRP functional warm ischemia time (fWIT) was increased significantly during the study period.
Conclusions
In this matched cohort, DCD heart recipients experienced increased acute rejection, both treated and nontreated, compared to DBD heart recipients. Despite differences in the techniques and likely in fWIT, acute rejection, survival, and other secondary outcomes are similar with DPP and TA-NRP.
期刊介绍：
The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.
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