近日，美国范德比尔特大学Ashish S. Shah团队研究了循环死亡后捐献心脏，无需预植入复苏，采用快速超氧合复苏进行心脏移植对患者预后的影响。2026年1月26日出版的《美国医学会杂志》发表了这项成果。

在循环死亡（DCD）后的成人心脏移植中，当用于年轻供体人群（16-30岁）和/或缺血时间较短（<4小时）的心脏时，延长超氧保存（REUP）的快速复苏已显示出很好的前景。

为了评估在不考虑供体年龄或预期缺血时间的情况下，REUP技术在成人终末期心脏病（DCD）心脏移植中的可行性，2024年11月至2025年7月，研究组在美国一家高容量心脏移植中心对24例接受REUP（逆转录病毒灭活处理）后恢复供体心脏（DCD，心脏死亡供体）成人心脏移植的患者进行病例系列研究。在无需植入前供体心脏复苏或机器灌注的情况下，使用暴露式逆行性心外膜灌注（REUP）进行心脏移植供体心脏恢复。主要结局为严重原发性移植物功能障碍、30天存活率以及首次心内膜活检时的急性排斥反应。

研究组共移植了24例经心脏停搏液复苏（REUP）后恢复的扩张型心肌病（DCD）心脏，供体平均年龄为32岁，其中9例（38%）供体年龄超过40岁。50%的受者既往接受过胸骨切开术。从最初宣布供体死亡到灌注的平均时间为9分钟。15例供体心脏（60%）的总缺血时间超过4小时，其中1例达到8小时。在受者中，30天存活率为96%。仅1例患者（4%）出现严重的原发性移植物功能障碍，另1例患者（4%）出现继发性移植物功能障碍。在初次心内膜活检中，1例患者（4%）出现急性细胞排斥反应2R级；未观察到抗体介导的排斥反应病例。

研究组证明了在广泛的供体和受体人群中，无论预期缺血时间如何，无需供体心脏复苏，REUP（区域性体外灌注）用于DCD（心脏死亡）心脏复苏的安全性、可行性和有效性。鉴于当前DCD心脏复苏策略的高成本和复杂性，以及常温区域灌注的伦理问题，REUP可能被证明是一种有前景的获取方法。需要进一步研究以支持这一新技术的持续推广。

附：英文原文

Title: Donation After Circulatory Death Heart Transplant Without Preimplant Reanimation Using Rapid Ultraoxygenated Recovery

Author: Aaron M. Williams, John Trahanas, Swaroop Bommareddi, Kevin C. McGann, Awab Ahmad, Brian Lima, Chen Chia Wang, Mark Petrovic, Stephen Devries, Joshua Lowman, Tarek Absi, Eric Quintana, Hasan Siddiqi, Kaushik Amancherla, Marshall Brinkley, Stacy Tsai, Jonathan N. Menachem, Dawn Pedrotty, Aniket S. Rali, Suzanne Sacks, Sandip Zalawadiya, Joey Lepore, Mias Pretorious, Kelly Schlendorf, Matthew Bacchetta, Ashish S. Shah

Issue&Volume: 2026-01-26

Abstract:

Importance  Rapid recovery with extended ultraoxygenated preservation (REUP) has shown promise in adult donation after circulatory death (DCD) heart transplant when used in younger donor populations (aged 16-30 years) and/or for hearts with shorter ischemic times (<4 hours).

Objective  To assess the feasibility of the REUP technique in adult DCD heart transplant, without regard to donor age or anticipated ischemic time.

Design, Setting, and Participants  Case series of 24 patients to undergo REUP-recovered DCD adult heart transplant at a single high-volume heart transplant center in the United States from November 2024 to July 2025.

Exposure  REUP used for DCD cardiac allograft recovery without preimplant donor heart reanimation or machine perfusion.

Main Outcomes and Measures  Severe primary graft dysfunction, 30-day survival, and acute rejection on first endomyocardial biopsy.

Results  Twenty-four REUP-recovered DCD hearts were transplanted, with a mean donor age of 32 years and 9 donors (38%) older than 40 years. Fifty percent of recipients had prior sternotomy. The mean time from initial declaration of donor death to flush was 9 minutes. Fifteen donor hearts (60%) had a total ischemic time longer than 4 hours, including 1 that was 8 hours. Among recipients, 30-day survival was 96%. Only 1 patient (4%) had severe primary graft dysfunction, and 1 other patient (4%) had secondary graft dysfunction. On initial endomyocardial biopsy, 1 patient (4%) had acute cellular rejection grade 2R; no cases of antibody-mediated rejection were observed.

Conclusions and Relevance  This study demonstrates the safety, feasibility, and efficacy of REUP for DCD heart recovery without donor heart reanimation in a broad population of donors and recipients and without regard to anticipated ischemic time. Given the high cost and complexity of current DCD heart recovery strategies, as well as ethical concerns surrounding normothermic regional perfusion, REUP may prove to be a promising procurement method. Further study is required to support continued expansion of this novel technique.

DOI: 10.1001/jama.2025.25169

Source: https://jamanetwork.com/journals/jama/fullarticle/2844448