长时间无脉动电活动热性缺血预测循环死亡心脏移植后捐献的死亡率和移植功能障碍
Aaron M Williams1, Chen Chia Wang2, Awab Ahmad1
1Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN.
The Journal of thoracic and cardiovascular surgery
|February 5, 2026
概括
长时间无脉动电活动等待时间 (PWIT) 超过12分钟在循环死亡 (DCD) 心脏移植后的捐赠与更糟糕的结果有关. 通过宣布PEA死亡来最大限度地减少PWIT可以改善成年人心脏移植的结果.
科学领域:
- 移植免疫学 移植免疫学
- 进行心血管外科手术.
- 器官捐赠和恢复器官的使用
背景情况:
- 循环死亡 (DCD) 后的心脏移植结果的捐赠受到延长的静心热缺血时间 (AWIT) 的负面影响.
- 尽管美国移植外科医生协会 (ASTS) 的建议,目前宣布DCD捐赠者的死亡的做法,特别是与无脉动电活动 (PEA) 相比的时间相比,缺乏一致性.
- 胸腔腹部正常热区域输液 (TA-NRP) 用于DCD捐赠者的器官恢复,需要评估与此技术相关的等待时间的影响.
研究的目的:
- 评估长时间无脉动电活动等待时间 (PWIT) 与接受TA-NRP恢复的DCD全移植的成年心脏移植患者的临床结果之间的关联.
- 确定PWIT预测不利结果的关键值.
- 为了告知DCD心脏移植协议的潜在改进.
主要方法:
- 在2020年1月至2025年2月期间,对使用TA-NRP恢复的DCD全移植的成年人心脏移植进行了回顾性审查.
- 排除标准包括多器官移植患者和患有先天性心脏病的患者.
- PWIT被定义为从静缩血压<30mmHg到TA-NRP开始的持续时间. 接收器操作特征 (ROC) 曲线分析确定了最佳的PWIT值,并使用治疗权重的逆概率 (IPTW) 来调整混因素.
主要成果:
- 该研究包括133名患者,PWIT的中位数为11分钟. 值得注意的是,42.9%的捐赠者没有在PEA上申报.
- 经过ROC分析,发现12分钟是预测90天死亡率的转折点.
- 与PWIT>12分钟 (25.6%) 的患者相比,与PWIT ≤12分钟的患者相比,严重的初级移植功能障碍 (OR 4.62),90天死亡率 (OR 7.67) 和1年死亡率 (OR 5.93) 的调整几率显著更高.
结论:
- 超过12分钟的PWIT是使用TA-NRP恢复的DCD心脏中增加死亡率和严重的初级移植功能障碍的重要预测因素.
- 标准化PEA的死亡声明,而不是等待心血管梗塞,至关重要.
- 实施尽量减少PWIT的策略对于改善DCD捐赠者的成年心脏移植接受者的术后结果至关重要.
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