BACKGROUND This study evaluates the impact of the agonal phase and related hemodynamic measures on post-transplant outcomes and heart utilization in donation after circulatory death (DCD) heart transplantation. METHODS United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation between January 1, 2019 and September 30, 2023. The recipients were stratified into 2 groups based on donor agonal period: <30 and ≥30 minutes. The primary outcome was 90-day post-transplant survival. Propensity score-matching was performed. Sub-analysis was performed to evaluate the association of agonal period with donor heart utilization. Additionally, the associations between different hemodynamic thresholds used to indicate onset of warm ischemia during the agonal phase with 90-day mortality were compared. RESULTS Eight hundred and eighty nine recipients were included, with 179 (20.1%) receiving hearts from donors with an agonal period of ≥30 minutes. Ninety-day survival (88.1% vs. 95.6%, p < 0.001) was significantly lower among the recipients of donors with an agonal period of ≥30 minutes. The lower 90-day survival persisted in a propensity score-matched comparison. Furthermore, longer agonal periods were associated with reduced donor heart utilization. Lastly, a time interval from a systolic blood pressure of 80 ± 5mmHg to death exhibited significantly higher association with 90-day mortality than a time interval from a systemic oxygen saturation 80 ± 5% to death. CONCLUSIONS Utilizing DCD donor hearts with agonal periods ≥30 minutes is associated with reduced post-transplant survival and decreased donor heart utilization. When assessing the onset of warm ischemia during the agonal phase, hypotension may serve as a more accurate indicator of myocardial ischemia and provide improved post-transplant prognostic insight than hypoxia.

中文翻译：

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循环死亡心脏移植后捐献的痛苦期持续时间与心脏利用和移植后结果的关联。


背景 本研究评估了濒死期和相关血流动力学指标对循环死亡 （DCD） 心脏移植后移植后结局和捐献心脏利用的影响。方法 查询器官共享联合网络登记处，以分析 2019 年 1 月 1 日至 2023 年 9 月 30 日期间接受孤立性 DCD 心脏移植的成年受者。根据供体激动期将受者分为 2 组： <30 和 ≥30 分钟。主要结局是移植后 90 天的生存率。进行倾向评分匹配。进行亚分析以评估痛苦期与供体心脏利用的相关性。此外，比较了用于指示痛苦期热缺血发作的不同血流动力学阈值与 90 天死亡率之间的关联。结果 纳入 889 名受者，其中 179 名 （20.1%） 接受供体心脏，痛苦时间为 ≥30 分钟。在痛苦期为 ≥30 分钟的供体接受者的 90 天生存率 （88.1% vs. 95.6%，p < 0.001） 显着降低。较低的 90 天生存率在倾向评分匹配的比较中持续存在。此外，较长的痛苦期与供体心脏利用率降低相关。最后，从收缩压 80 ± 5mmHg 到死亡的时间间隔与 90 天死亡率的相关性显著高于从体循环氧饱和度 80 ± 5% 到死亡的时间间隔。结论 使用痛苦期 ≥30 分钟的 DCD 供体心脏与移植后生存率降低和供体心脏利用率降低有关。 在评估痛苦期温缺血的发作时，低血压可能是更准确的心肌缺血指标，并且比缺氧提供更好的移植后预后信息。