DCD donations and outcomes of heart transplantation: the Australian experience.
Cardiac transplantation
Donation after circulatory death
Extra-corporeal heart perfusion
Journal
Indian journal of thoracic and cardiovascular surgery
ISSN: 0973-7723
Titre abrégé: Indian J Thorac Cardiovasc Surg
Pays: India
ID NLM: 8700105
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
04
04
2020
revised:
13
05
2020
accepted:
23
06
2020
entrez:
16
10
2020
pubmed:
17
10
2020
medline:
17
10
2020
Statut:
ppublish
Résumé
There is increasing clinical utilization of hearts from the donation after circulatory death (DCD) pathway with the aim of expanding the donor pool and mitigating the ever-present discrepancy between the inadequate availability of good quality donor hearts and the rising number of patients with end-stage heart failure. This article reviews the rationale, practice, logistical factors, and 5-year experience of DCD heart transplantation at St Vincent's Hospital, Sydney. Between July 2014 and July 2019, 69 DCD donor retrievals were undertaken resulting in 49 hearts being instrumented on an ex situ normothermic cardiac perfusion device. Seventeen (35%) of these hearts were declined and the remaining 32 (65%) were used for orthotopic DCD heart transplantation. At 5 years of follow-up, the 1-, 3-, and 5-year survival was 96%, 94%, and 94% for DCD hearts compared with 89%, 83%, and 82% respectively for donation after brain death (DBD) hearts (n.s). The immediate post-implant requirement for temporary extra-corporeal membrane oxygenation (ECMO) support for delayed graft function was 31% with no difference in rejection rates when compared with the contemporaneous cohort of patients transplanted with standard criteria DBD hearts. DCD heart transplantation has become routine and incorporated into standard clinical practice by a handful of pioneering clinical transplant centres. The Australian experience demonstrates that excellent medium-term outcomes are achievable from the use of DCD hearts. These outcomes are consistent across the other centres and consequently favour a more rapid and wider uptake of heart transplantation using DCD donor hearts, which would otherwise be discarded.
Identifiants
pubmed: 33061207
doi: 10.1007/s12055-020-00998-x
pii: 998
pmc: PMC7538519
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
224-232Informations de copyright
© Indian Association of Cardiovascular-Thoracic Surgeons 2020.
Déclaration de conflit d'intérêts
Conflict of interestThe authors declare that they have no conflict of interest.
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