The Rapidly Evolving Landscape of DCD Heart Transplantation

期刊论文
出版模式：

开放获取
发表日期：

2024年10月9日

查看全文

Yashutosh Joshi,
Katherine Wang,
Campbell MacLean,
Jeanette Villanueva,
Ling Gao,
Alasdair Watson,
Arjun Iyer,
Mark Connellan,
Emily Granger,
Paul Jansz,
Peter Macdonald

摘要

Purpose of Review

To summarise current international clinical outcomes from donation after circulatory death heart transplantation (DCD-HT); discuss procurement strategies, their impact on outcomes and overall organ procurement; and identify novel approaches and future areas for research in DCD-HT.

Recent Findings

Globally, DCD-HT survival outcomes (regardless of procurement strategy) are comparable to heart transplantation from brain dead donors (BDD). Experience with normothermic machine perfusion sees improvement in rates of primary graft dysfunction. Techniques have evolved to reduce cold ischaemic exposure to directly procured DCD hearts, though controlled periods of cold ischaemia can likely be tolerated. There is interest in hypothermic machine perfusion (HMP) for directly procured DCD hearts, with promising early results.

Summary

Survival outcomes are firmly established to be equivalent between BDD and DCD-HT. Procurement strategy (direct procurement vs. regional perfusion) remains a source of debate. Methods to improve allograft warm ischaemic tolerance are of interest and will be key to the uptake of HMP for directly procured DCD hearts.