JHLT open · 2026
Distinct goal-directed perfusion signatures in donation after brain death versus circulatory death heart transplantation.
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Wang Chen Chia, Ahmad Awab, Petrovic Mark, McGann Kevin, Williams Aaron, Trahanas John, Bommareddi Swaroop, Absi Tarek, Quintana Eric, Rali Aniket, Schlendorf Kelly, Bacchetta Matthew, Shah Ashish, Lima Brian
Аннотация
BACKGROUND: Continuous oxygen extraction ratio (O2ER) monitoring during cardiopulmonary bypass is an emerging strategy to support goal-directed perfusion (GDP) during heart transplantation (HT). Because donation after circulatory death (DCD) introduces additional warm ischemia, we examined whether post-reperfusion O2ER dynamics differ from donation after brain death (DBD).
METHODS: Adult HT at a single center (10/2021-06/2025) with continuous perfusion data were retrospectively reviewed. O2ER was calculated as oxygen consumption/oxygen delivery index (DO2i). The primary endpoint was O2ER after graft reperfusion (cross-clamp removal), quantified as the area above O2ER of 0.25. Weighted regression after adjusting for baseline characteristics identified the association of DCD status, pre-reperfusion O2ER, and post-reperfusion DO2i on post-reperfusion O2ER.
RESULTS: Among 322 HT, 193 (59.9%) were DBD and 129 (40.1%) were DCD. Pre-reperfusion DO2i and O2ER, and post-reperfusion O2ER were similar between DBD and DCD cohorts. Weighted regression analysis demonstrated that DCD donor status (mean difference 0.36, 95% CI 0.11-0.60), pre-reperfusion area above O2ER 0.25 (mean difference 0.39, 95% CI 0.29-0.50), and post-reperfusion time below DO2i 280 mL/min/m² (mean difference 0.05, 95% CI 0.03-0.07) were all independently associated with post-reperfusion area above O2ER 0.25. The interaction term between DCD donor status and pre-reperfusion O2ER was also significantly associated with post-reperfusion O2ER (mean difference -0.27, 95% -0.41 - -0.14).
CONCLUSIONS: DCD grafts exhibit persistently higher O2ER profiles and reduced metabolic responsiveness to pre-reperfusion optimization. These findings underscore the need for individualized, real-time O2ER-guided GDP to dynamically match perfusion to graft and patient-specific metabolic demands.
METHODS: Adult HT at a single center (10/2021-06/2025) with continuous perfusion data were retrospectively reviewed. O2ER was calculated as oxygen consumption/oxygen delivery index (DO2i). The primary endpoint was O2ER after graft reperfusion (cross-clamp removal), quantified as the area above O2ER of 0.25. Weighted regression after adjusting for baseline characteristics identified the association of DCD status, pre-reperfusion O2ER, and post-reperfusion DO2i on post-reperfusion O2ER.
RESULTS: Among 322 HT, 193 (59.9%) were DBD and 129 (40.1%) were DCD. Pre-reperfusion DO2i and O2ER, and post-reperfusion O2ER were similar between DBD and DCD cohorts. Weighted regression analysis demonstrated that DCD donor status (mean difference 0.36, 95% CI 0.11-0.60), pre-reperfusion area above O2ER 0.25 (mean difference 0.39, 95% CI 0.29-0.50), and post-reperfusion time below DO2i 280 mL/min/m² (mean difference 0.05, 95% CI 0.03-0.07) were all independently associated with post-reperfusion area above O2ER 0.25. The interaction term between DCD donor status and pre-reperfusion O2ER was also significantly associated with post-reperfusion O2ER (mean difference -0.27, 95% -0.41 - -0.14).
CONCLUSIONS: DCD grafts exhibit persistently higher O2ER profiles and reduced metabolic responsiveness to pre-reperfusion optimization. These findings underscore the need for individualized, real-time O2ER-guided GDP to dynamically match perfusion to graft and patient-specific metabolic demands.