The United Kingdom National Programme of DCD heart transplantation: Timings, techniques, feasibility, and outcomes with abdominal normothermic regional perfusion.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Morcos Karim, Simmonds Lewis, Rushton Sally, Hogg Rachel, Messer Simon, Macklam Debbie, Husain Mubbasher, Large Stephen, Tsui Steven, Kaul Pradeep, Smail Hassiba, Mohite Prashant, Priasamy Sri Aurovind, Baxter Jennifer, Nunes Jp, Pettit Stephen, Curry Philip, Doshi Hari, Nair Sukumaran, Osman Mohamed, Page Aravinda, Zych Bart, Monteagudo-Vela María, Ranasinghe Aaron, Mukadam Majid, Quinn David, Mehta Vipin, Pai Vasudev, Russell Derval, Saez Diana Garcia, Venkateswaran Rajamiyer, Ramesh B C, Dronavalli Vamsidhar, Jungschleger Jerome, Kenny Louise, Simmonds Jacob, Macgowan Guy, Reinhardt Zdenka, Speed Jane, Parameshwar Jayan, Jenkins David, Watson Sarah, Marley Fiona, Ali Ayesha, Gardner Dale, Rubino Antonio, Whitney Julie, Slater Catherine, Armstrong Liz, Foley Jeanette, Ryan Marian, Gibson Sharon, Quinn Karen, Macleod Anna-Maria, Spence Susan, Johnston Chris, Butler Andrew, Watson Chris, Clarkson Anthony, Manas Derek, Currie Ian, Berman Marius
Аннотация
METHODS: This multi-center, retrospective, observational study compared DCD versus donation after brain death (DBD) heart transplant outcomes from 2020 to 2024. DCD hearts were retrieved using direct procurement and perfusion (DPP) with/without abdominal normothermic regional perfusion (A-NRP). Primary outcomes were 1-year survival and severe primary graft dysfunction (PGD). Ischemic times, cannulation techniques, and A-NRP status were analyzed.
RESULTS: There were 188 DCD and 523 DBD heart transplants. There was no difference in 30-day (96% DCD vs 95% DBD, p = 0.76) or 1-year survival (87% DCD vs 88% DBD, p = 0.81). There was no difference in severe PGD (unadjusted analysis; 28% DCD vs 24% DBD, p = 0.26). DPP with A-NRP increased ischemic timings (asystole to cardioplegia delivery, 15 mins (n = 22; A-NRP/DPP) vs 13 mins (n = 166; DPP, p = 0.0022). Propensity-matched analysis showed no difference in 90-day survival (86.4% vs 88.6%; p = 0.7828). Papworth cannulation technique reduced ischemic times with no impact on outcomes. Longer implant (p = 0.03) and ex-situ perfusion (p = 0.02) times were associated with severe PGD/death at 1 year.
CONCLUSION: DCD heart donation increased UK heart transplantation by 36% compared with DBD alone, with results comparable to DBD. A-NRP/DPP is feasible but prolongs ischemic times, although survival was similar to the DPP group. The main predictors of poor 1-year survival were implant and ex-situ perfusion times.