Since 2019, the annual transplantation rate of hearts donated following circulatory death (DCD) has increased significantly in the United States. The two major heart procurement techniques following circulatory death are direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). Post-transplant survival for heart recipients has not been compared between these two techniques. This observational study uses data on adult heart transplants from donors after circulatory death from January 1, 2019, to December 31, 2021, in the Scientific Registry of Transplant Recipients. We identified comparable transplant cases across procurement types using propensity-score matching and measured the association between procurement technique and 1-year post-transplant survival using Kaplan-Meier and mixed-effect Cox proportional hazards models with random intercepts for each center. Among 318 DCD heart transplants, 216 (68%) were procured via DPP, and 102 (32%) via NRP. Among 22 transplant centers that accepted circulatory-death donors, 3 used NRP exclusively, and 5 used both procurement techniques. After propensity-score matching on recipient and donor factors, there was no significant difference in one-year post-transplant survival (93.1% for NRP vs 91.1% for DPP, p = 0.79) between procurement techniques. NRP and DPP procurements are associated with similar one-year post-transplant survival. If NRP is ethically permissible and improves outcomes for abdominal organs, it should be the preferred procurement technique for DCD hearts. The data that support the findings of this study are available from the Scientific Registry of Transplant Recipients (SRTR). Restrictions apply to the availability of these data, which were used under license for this study.

中文翻译：

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死亡心脏移植循环测定后常温局部灌注与直接采购和捐赠灌注后的移植后存活率

自2019年以来，美国每年循环死亡（DCD）捐献心脏的移植率显着增加。循环死亡后两种主要的心脏获取技术是直接获取和灌注（DPP）和常温局部灌注（NRP）。尚未对这两种技术之间的心脏移植后存活率进行比较。这项观察性研究使用了移植受者科学登记处2019年1月1日至2021年12月31日期间循环死亡后捐献者的成人心脏移植数据。我们使用倾向评分匹配确定了不同采购类型的可比移植病例，并使用每个中心随机截距的 Kaplan-Meier 和混合效应 Cox 比例风险模型测量了采购技术与移植后 1 年生存率之间的关联。在 318 例 DCD 心脏移植中，216 例（68%）是通过 DPP 获得的，102 例（32%）是通过 NRP 获得的。在接受循环死亡供体的 22 家移植中心中，3 家专门使用 NRP，5 家同时使用两种采购技术。对受者和供者因素进行倾向评分匹配后，采购技术之间的移植后一年生存率没有显着差异（NRP 为 93.1%，DPP 为 91.1%，p = 0.79）。NRP 和 DPP 采购与相似的移植后一年存活率相关。如果 NRP 在伦理上是允许的并且可以改善腹部器官的结果，那么它应该是 DCD 心脏的首选采购技术。支持本研究结果的数据可从移植受者科学登记处 (SRTR) 获取。这些数据的可用性受到限制，这些数据是在本研究的许可下使用的。