Clinical Outcomes With Normothermic Pulsatile Organ Perfusion in Heart Transplantation: A Report From the OCS Heart Perfusion Registry.
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Stehlik Josef, Farr Maryjane A, Mehra Mandeep R, Schroder Jacob N, D'Alessandro David A, Pal Jay D, Villavicencio Mauricio A, Gruber Peter J, Couper Gregory S, Shudo Yasuhiro, Patel Parag C, Daneshmand Mani A, Klein Liviu, Shah Ashish S, Skipper Eric R, Esmailian Fardad, Goldstein Daniel, Ohira Suguru, Lozonschi Lucian, Kaczorowski David J, Takeda Koji, Malyala Rajasekhar S R, Haft Jonathan W, Meyer Dan M, Sun Benjamin C, Pretorius Victor, Kilic Arman, Anyanwu Anelechi C, Williams Celeste T, Pham Duc T, Kai Masashi, Sulemanjee Nasir Z, Itoh Akinobu, Funamoto Masaki, Salerno Christopher T, Ikonomidis John S, Durham Lucian A, Shaffer Andrew, Zhou Xiang, Zafar Farhan, Pinney Sean P, Milano Carmelo A
Аннотация
METHODS: The OCS Heart Perfusion Registry collects data on US heart transplantations using the OCS, static cold storage (SCS), or thoracoabdominal normothermic regional perfusion (NRP) and donor hearts recovered from DBD or DCD donors. We analyzed donor and recipient characteristics and posttransplantation outcomes in patients transplanted with OCS donor hearts (either DBD or DCD) compared with SCS hearts, and with OCS hearts from DCD donors compared with those recovered with NRP followed by SCS. Propensity score matching was used in survival analyses to adjust for differences among recipient characteristics.
RESULTS: Between 2021 and 2023, 3225 consecutive heart transplantations enrolled from 56 centers were analyzed in the Heart Perfusion Registry. The OCS was used in 854 of 3225 heart transplantations (26.4%), among which 340 (39.8%) were DBD and 514 (60.2%) were DCD donors, whereas 2174 DBD donors were recovered with SCS and another 197 DCD donors with NRP techniques. The OCS-DBD group experienced a greater number of organ offer refusals before final acceptance (13 versus 6; Wilcoxon rank sum, P<0.001) and a longer transport distance (667 miles versus 232 miles; Wilcoxon rank sum, P<0.001) compared with SCS-DBD. Survival at 12 months was similar between the 2 groups (89.9% for OCS-DBD versus 90.6% for SCS-DBD; marginal Cox model, P=0.54). Among the OCS-DCD and SCS-DBD groups, survival at 12 months was also similar (91.0% versus 92.5%, respectively; marginal Cox model, P=0.32). The OCS-DCD and NRP-DCD groups demonstrated similar survival (91.0% versus 91.7%, respectively; log rank, P=0.63), although the transport distance was longer in OCS-DCD compared with DCD with NRP followed by SCS (400 miles versus 223 miles; Wilcoxon rank sum, P<0.001). By 2023, 90% of all OCS donor management and recovery was performed with dedicated organ recovery teams.
CONCLUSIONS: We demonstrate that real-world implementation of the OCS for DBD donors (using predominantly a dedicated recovery team) is associated with expanded donor criteria, longer transport distance, and excellent posttransplantation outcomes. In OCS-DCD donors, outcomes parallel those of donors recovered with NRP-DCD and compare favorably with DBD donor organs.