Early Renal Outcomes Following Heart Transplantation Using Organs Procured After Circulatory Death.

Autor: Zhou JC; Department of Medicine Massachusetts General Hospital Boston MA USA., Sise ME; Nephrology Division Massachusetts General Hospital Boston MA USA., Drezek K; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Wolfe SB; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Osho AA; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Prario MN; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Rabi SA; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Michel E; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Tsao L; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Coglianese E; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Doucette M; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Newton-Cheh C; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Thomas S; Cardiology Division University of Washington Seattle WA USA., Ton VK; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Sutaria N; Cardiology Division Emory Heart and Vascular Center Atlanta GA USA., Schoenike MW; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Christ AM; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Paneitz DC; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Villavicencio M; Department of Cardiovascular Surgery Mayo Clinic Rochester MN USA., Madsen JC; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA.; Center for Transplantation Sciences, Department of Surgery Massachusetts General Hospital Boston MA USA., Pierson R; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Lewis GD; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., D'Alessandro DA; Divison of Cardiac Surgery Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA., Zlotoff DA; Cardiology Division Corrigan Minehan Heart Center, Massachusetts General Hospital Boston MA USA.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Oct 15; Vol. 13 (20), pp. e035443. Date of Electronic Publication: 2024 Oct 08.
DOI: 10.1161/JAHA.124.035443
Abstrakt: Background: Transplantation using hearts obtained through donation after circulatory death (DCD) is increasing, but data on recipient renal outcomes are limited.
Methods and Results: Patients at a single institution who underwent heart transplantation using organs procured through DCD or donation after brain death (DBD) from April 2016 to August 2022 were included in this retrospective cohort study. Hemodynamic measures were collected via right heart catheterization performed 1 week after transplantation. Posttransplantation renal outcomes included estimated glomerular filtration rate at 1 week, 4 weeks, and 16 weeks, and the incidence of acute kidney injury (AKI) and renal replacement therapy within 1 week. The analysis included 225 patients (55 recipients of DCD). Baseline characteristics were comparable between recipients of DCD and DBD. Renal outcomes within 1 week posttransplantation in recipients of DCD were similar to recipients of DBD, including percent change in estimated glomerular filtration rate (-37.9% [-58.6 to -6.2] versus -31.9% [-52.4 to -9.9]; P =0.91), incidence of AKI (47.3% versus 46.5%; P >0.99) and incidence of renal replacement therapy (3.6% versus 4.7%; P >0.99). Recipients of DCD with AKI within 1 week ("early AKI") did not recover to baseline estimated glomerular filtration rate (75.8 [60.2-91.3] mL/min per 1.73 m 2 ) by week 16 (59.3 [46.9-73.6] mL/min per 1.73 m 2 ; P =0.002), whereas recipients without early AKI exhibited comparable estimated glomerular filtration rate to baseline by week 4 (84.5 [70.8-98.5] mL/min per 1.73 m 2 ; P =0.084). Similar trends were observed in recipients of DBD.
Conclusions: Recipients of DCD demonstrated similar renal outcomes compared with recipients of DBD, supporting the ongoing use of DCD transplantation. Early AKI was associated with persistent renal dysfunction for recipients of both DCD and DBD.
Databáze: MEDLINE
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