Donation After Circulatory Death Cardiac Recovery Technique: Single-Center Observational Outcomes.

Autor:	Pasrija C; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., DeBose-Scarlett A; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Siddiqi HK; Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., DeVries SA; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Keck CD; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Scholl SR; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Warhoover M; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Schlendorf KH; Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Shah AS; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Trahanas JM; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: john.trahanas@vumc.org.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2024 Dec; Vol. 118 (6), pp. 1299-1307. Date of Electronic Publication: 2024 Aug 14.
DOI:	10.1016/j.athoracsur.2024.07.033
Abstrakt:	Background: Recovery of hearts from donation after circulatory death donors has been performed either with direct procurement and perfusion (DPP) using the TransMedics Organ Care System or with normothermic regional perfusion (NRP) with subsequent cold storage. It remains unclear which of these 2 strategies yields optimal posttransplant outcomes. Methods: All heart transplant recipients from donors after circulatory death donors at the Vanderbilt University Medical Center (Nashville, TN) were reviewed (February 2020 to January 2023). Recipients were stratified into an NRP or DPP cohort. All DPP recoveries were performed using the TransMedics Organ Care System. The key outcome was severe primary graft dysfunction at 24 hours, defined by the need for postoperative extracorporeal membrane oxygenation. Results: A total of 118 hearts were transplanted (NRP, 87; DPP, 31). Donors recovered using NRP were younger (25 years [interquartile range {IQR}, 21-31 years] vs 31 years [IQR, 24-37 years]; P = .008) and had shorter distance traveled (292 miles [158-516 miles] vs 449 miles [IQR, 248-635 miles]; P = .02). Recipient preoperative risk factors were similar between the groups. There was no difference in the incidence of severe primary graft dysfunction at 24 hours (NRP, 5.8%; and DPP, 12.9%; P = .24). However, ejection fraction at 7 days after transplantation was higher in the NRP group (65% [IQR, 60%-65%] vs 60% [IQR, 60%-68%]; P = .005). There was no difference in inotrope scores at 24 hours (P = 1.00) or 72 hours (P = .87) or in 30-day (NRP, 95% vs DPP, 97%; P = .75) and 1-year (NRP, 94% vs DPP, 86%; P = .19) survival. Conclusions: NRP and DPP strategies for recovery of cardiac allografts yield comparable early allograft outcomes. Future studies are needed to confirm these findings in larger prospective cohorts. Competing Interests: Disclosures The authors have no conflicts of interest to disclose. (Published by Elsevier Inc.)
Databáze:	MEDLINE
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