OBJECTIVE This study compares the incidence of severe Primary Graft Dysfunction (PGD) in a contemporaneous cohort of donors after circulatory death (DCD) and brain death (DBD) heart transplant recipients. METHOD The United Network for Organ Sharing database was queried for isolated adult heart transplant recipients from 9/2023 to 6/2024. Heart recipients were stratified based on the organ donation type (DCD vs DBD). DCD heart recipients were further categorized based on the procurement method: time between circulatory death to cross-clamp: ≤ 30 minutes (Direct Procurement and Preservation, DPP), >30 minutes (Normothermic Regional Perfusion, NRP). Outcomes of interest included: severe PGD (Left/Bi-Ventricular; LV/BiV) at 24 hours and Severe Graft Dysfunction at 72 hours (patients with severe PGD at 24 hours that remain on mechanical support at 72 hours). RESULTS A total of 2590 adult heart transplant recipients were identified, of which 17.1% underwent DCD heart transplantation. DCD heart recipients were less likely to be on inotrope (36.7% vs 41.6%, p=0.046) and ECMO (4.1% vs 9.9%, p<0.001) prior to transplant than DBD heart recipients. DCD heart recipients were more likely than DBD heart recipients to develop severe PGD (LV/BiV) at 24 hours (9.5% vs 5.1%, p<0.001). The Severe Graft Dysfunction at 72 hours (2.3% vs 2.9%, p=0.67) and 30-day mortality were similar between the 2 groups. Recipients of DCD heart procured with DPP or NRP had similar severe PGD (LV/BiV) at 24 hours (9.4% vs 9.7%, p=0.93). CONCLUSION Severe PGD at 24 hours is higher among the DCD than DBD heart recipients, but Graft Dysfunction improves by 72 hours.

中文翻译：

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循环死亡后使用供体心脏的心脏移植受者严重原发性移植物功能障碍：美国经验。


目的 本研究比较了循环死亡 （DCD） 和脑死亡 （DBD） 心脏移植受者后同期供体队列中严重原发性移植物功能障碍 （PGD） 的发生率。方法 查询 2023 年 9 月至 2024 年 6 月的器官共享联合网络数据库以获取离体成人心脏移植受者。心脏受者根据器官捐献类型 （DCD vs DBD） 进行分层。根据获取方法进一步分类 DCD 心脏受者： 循环死亡与夹夹之间的时间：≤ 30 分钟（直接采购和保存，DPP），>30 分钟（正常区域灌注，NRP）。感兴趣的结果包括：严重的 PGD（左/双心室;LV/BiV）和 72 小时严重移植物功能障碍（24 小时严重 PGD 患者在 72 小时时仍接受机械支持）。结果 共确定了 2590 例成人心脏移植受者，其中 17.1% 接受了 DCD 心脏移植。与 DBD 心脏受者相比，DCD 心脏受者在移植前接受正性肌力药物 （36.7% vs 41.6%，p=0.046） 和 ECMO （4.1% vs 9.9%，p<0.001） 的可能性较小。DCD 心脏受者比 DBD 心脏受者更有可能在 24 小时时发展为严重的 PGD （LV/BiV） （9.5% vs 5.1%，p<0.001）。两组之间 72 小时严重移植物功能障碍 （2.3% vs 2.9%，p=0.67） 和 30 天死亡率相似。用 DPP 或 NRP 购买的 DCD 心脏受者在 24 小时时具有相似的严重 PGD （LV/BiV） （9.4% vs 9.7%，p = 0.93）。结论 DCD 患者 24 小时重度 PGD 高于 DBD 心脏受者，但移植物功能障碍改善 72 小时。