Expanding Horizons in Cardiac Transplant: Efficacy and Outcomes of Circulatory and Brain Death Donor Hearts in a Newly Implemented Cardiac Transplant Program with Limited Donor Accessibility and a Literature Review
Abstract
:1. Introduction
2. Method
2.1. Study Design
2.2. Organ Procurement and Management
2.3. Clinical Outcomes
2.4. Statistical Analysis
3. Results
3.1. DCD and DBD Recipients, Donors, and Basal Characteristics of Procedure
3.2. Survival and Secondary Outcomes
3.3. Potential Impact of Adult DCD in the Canarian CT Program
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CT | cardiac transplantation |
DBD | donation after brain death |
DCD | donation after circulatory death |
DP | direct procurement |
ECMO | extracorporeal membrane oxygenation |
ESMP | ex situ machine perfusion |
ICU | intensive care unit |
KM | Kaplan–Meier |
PGD | primary graft dysfunction |
RRT | renal replacement therapy |
SAT | supra-aortic trunks |
SCS | static cold storage |
TANRP | thoraco-abdominal normothermic regional perfusion |
TCD | transcranial Doppler |
WLST | withdrawal of life support treatment |
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Characteristics | DBD n = 64 | DCD n = 12 | p-Value |
---|---|---|---|
RECIPIENTS | |||
Age, y | 58 (50–63) | 55 (52.75–61.75) | 0.792 |
Male sex, n (%) | 51 (80) | 9 (75) | 0.708 |
BMI | 25.23 (22.08–27.21) | 27.48 (24.18–30.17) | 0.176 |
Ischemic etiology, n (%) | 22 (34.4) | 6 (50) | 0.341 |
Insulin-dependent diabetes, n (%) | 14 (21.9) | 4 (33.3) | 0.463 |
Moderate–severe COPD, n (%) | 5 (7.8) | 1 (8.3) | 1 |
Chronic kidney disease, n (%) | 41 (64.1) | 10 (83.3) | 0.317 |
Previous cardiac surgery, n (%) | 10 (15.6) | 1 (8.3) | 1 |
PVR, UW | 1.83 (1.4–2.44) | 1.91 (1.36–2.29) | 0.74 |
Creatinine, mg/dL | 1.3 (1.02–1.63) | 1.37 (0.88–1.84) | 0.784 |
Bilirubin > 2 mg/dL | 8 (12.7) | 0 | 0.341 |
Urgent Transplant, n (%) | 5 (7.3) | 1 (8.3) | 1 |
Intravenous inotropes before CT, n (%) | 18 (28,12) | 4 (33.33) | 0.72 |
Time on waitlist (days) | 40.5 (9.75–95.5) | 11 (4.75–49.5) | 0.127 |
Pretransplant mechanical ventilation (days) | 5 (7.8) | 1 (8.3) | 1 |
Pretransplant circulatory support, n (%) | 13 (20.3) | 2 (16.7) | 1 |
-None | 48 (78.7) | 9 (81.8) | |
-Balloon pump | 7 (11.5) | 1 (9.1) | |
-ECMO | 4 (6.6) | 1 (9.1) | |
-Ventricular support | 2 (3.3) | 0 | |
DONORS AND PROCEDURE | |||
Age, y | 47 (35.75–57.25) | 46 (42–48.25) | 0.727 |
Male sex, n (%) | 55 (85.9) | 11 (91.7) | 1 |
Weight, kg | 83.5 (72.75–90) | 72 (66.5–76.5) | 0.012 |
BMI | 26.18 (23.75–29.34) | 23.4 (20.48–24.72) | 0.01 |
Hypertension, n (%) | 14 (22.2) | 3 (25) | 1 |
Diabetes Mellitus, n (%) | 3 (4.8) | 0 | 1 |
Current smoker, n (%) | 26 (41.3) | 3 (25) | 0.349 |
Size mismatch | 18.91 (2.76–41.12) | 9.1 (−19.45–23.84) | 0.2 |
Sex mismatch (Female donor–male recipient), n (%) | 4 (6.2) | 0 | 1 |
Donor left ventricular ejection fraction, % | 60 (60–65) | 62.5 (60–65.75) | 0.456 |
Pre-donation echocardiogram, n (%) | |||
Dysfunction | 7 (10.9) | 1 (8.3) | 1 |
Left ventricular hypertrophy | 5 (8.6) | 1 (10) | 1 |
Ischemia time (min) | 146.5 (120–180) | 118.5 (102.75–152) | 0.106 |
Extracorporeal circulation time (min) | 103 (91.5–118) | 96 (84.75–107) | 0.185 |
DBD n = 64 | DCD n = 12 | p-Value | |
---|---|---|---|
Morbidity | |||
Primary graft disfunction | 6 (9.4) | 0 | 0.581 |
Postoperative atrial fibrillation | 12 (18.8) | 1 (8.3) | 0.679 |
Acute renal failure | 36 (56.2) | 7 (58.3) | 1 |
Renal replacement therapy in critical care unit | 18 (28.1) | 7 (58.3) | 0.052 |
Intubation time, hours | 9.5 | 8.5 | 0.562 |
Intensive care unit stay, days | 7 (5–11.25) | 10 (6.75–14.75) | 0.142 |
Total hospital stay, days | 21 (17–37.25) | 46 (22–70) | 0.021 |
Mortality | |||
30 d survival | 95 | 100 | NA |
6-month survival | 94 | 100 | NA |
1-year survival | 93.7 | 100 | NA |
Maastricht Classification | Presentation of Death | Definition |
---|---|---|
I | Dead in the out-of-hospital setting | 1A. Cardiocirculatory death outside hospital with no witness. Totally uncontrolled. 1B. Cardiocirculatory death outside hospital with witnesses and rapid resuscitation attempt. Uncontrolled. |
II | Unsuccessful resuscitation | 2A. Unexpected cardiocirculatory death in ICU. Uncontrolled. 2B. Unexpected cardiocirculatory death in hospital (ER or ward), with witnesses and rapid resuscitation attempt. Uncontrolled. |
III | Awaiting cardiac arrest | 3A. Expected cardiocirculatory death in ICU. Controlled. 3B. Expected cardiocirculatory death in OR (withdrawal phase > 30 min). Controlled. 3C. Expected cardiocirculatory death in OR (withdrawal phase < 30 min). (Highly) controlled. |
IV | Cardiac arrest while brain death | 4A. Unexpected cardio circulatory arrest in a brain-dead donor (in ICU). Uncontrolled. 4B. Expected cardiocirculatory arrest in a brain-dead donor (in OR or ICU). (Highly) controlled. |
V | Euthanasia | 5A. Medically assisted cardiocirculatory death in ICU or ward. Controlled. 5B. Medically assisted cardiocirculatory death in OR. Highly controlled. |
Study (Author/Country/Year) | Design | Procurement Technique (n) | Donors | Recipients | Outcomes | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age (y) | Male (%) | Age (y) | Male (%) | Severe PGD (%) | 30-Day Survival (%) | 6-Month Survival (%) | 1-Year Survival (%) | |||||||||||
Total | DPP-ESM | TANRP | Total | DPP-ESM | TANRP | Total | DPP-ESM | TANRP | Total | DPP-ESM | TANRP | |||||||
Messer et al. UK 2020 [7] | CS, SC, R, PSM | DP-ESMP (57) + TANRP-ESMP (22) | 35 | 84 | 55 | 77 | 34 | 37 | 26 | 97 | 95 | 100 | NA | NA | NA | 91 | 86 | 100 |
Kwon et al. USA 2022 [6] | RS, MC, R, PSM | DP-ESMP (175) + TANRP (47) | 29 | 87.3 | 57 | 76.4 | 14.4 | NA | NA | 99.1 | 98.8 | 100 | 93.5 | 92.9 | 96.6 | 92.5 | 91.7 | 96.6 |
Joshi et al. Australia 2023 [8] | SC, R | DP-ESMP (74) | 32 | 83.8 | 53 | 83.8 | 16 | 16 | - | NA | - | - | NA | - | - | 94 | 94 | - |
Louca et al. UK, Spain USA, Belgium 2023 [5] | CS, MC, R | TANRP -ESMP (21) + TANRP-SCS (136) | 32 | 83.4 | 56 | 78.3 | 12.8 | - | - | 96.8 | NA | 96.8 | NA | NA | NA | 93.2 | NA | 93.2 |
Schroder et al. USA 2023 [11] | CT, MC | DP-ESMP (80) | 29.3 | 93 | 51.3 | 73 | 15 | 15 | - | NA | - | - | 94 | 94 | - | NA | - | - |
Siddiqi et al. USA 2023 [9] | CS, SC, R | DP-ESMP (21) + TANRP-SCS (101) | 26 | 68 | 59 | 84 | 5.7 | NA | NA | 96.7 | NA | NA | 94.3 | NA | NA | 94.3 | NA | NA |
Hess et al. USA 2023 [10] | RS, MS, R | DP-ESMP (344) + TANRP (189) | 29 | 86.7 | 57 | 79.7 | NA | NA | NA | 96.8 | 96.8 | 98.2 | NA | NA | NA | 92.8 | 91.7 | 93.6 |
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Groba Marco, M.d.V.; Cabrera Santana, M.; Galvan Ruiz, M.; Fernandez de Sanmamed, M.; Romero Lujan, J.L.; Gonzalez Martin, J.M.; Santana Ortega, L.; Espinar, M.V.; Portela Torron, F.; Peña Morant, V.; et al. Expanding Horizons in Cardiac Transplant: Efficacy and Outcomes of Circulatory and Brain Death Donor Hearts in a Newly Implemented Cardiac Transplant Program with Limited Donor Accessibility and a Literature Review. J. Clin. Med. 2024, 13, 4972. https://doi.org/10.3390/jcm13174972
Groba Marco MdV, Cabrera Santana M, Galvan Ruiz M, Fernandez de Sanmamed M, Romero Lujan JL, Gonzalez Martin JM, Santana Ortega L, Espinar MV, Portela Torron F, Peña Morant V, et al. Expanding Horizons in Cardiac Transplant: Efficacy and Outcomes of Circulatory and Brain Death Donor Hearts in a Newly Implemented Cardiac Transplant Program with Limited Donor Accessibility and a Literature Review. Journal of Clinical Medicine. 2024; 13(17):4972. https://doi.org/10.3390/jcm13174972
Chicago/Turabian StyleGroba Marco, Maria del Val, Miriam Cabrera Santana, Mario Galvan Ruiz, Miguel Fernandez de Sanmamed, Jose Luis Romero Lujan, Jesus Maria Gonzalez Martin, Luis Santana Ortega, María Vazquez Espinar, Francisco Portela Torron, Vicente Peña Morant, and et al. 2024. "Expanding Horizons in Cardiac Transplant: Efficacy and Outcomes of Circulatory and Brain Death Donor Hearts in a Newly Implemented Cardiac Transplant Program with Limited Donor Accessibility and a Literature Review" Journal of Clinical Medicine 13, no. 17: 4972. https://doi.org/10.3390/jcm13174972