CC:体外心肺复苏后的器官捐献：一项全国性回顾性队列研究

Abstract

Background: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest.有关器官捐献实践和受体结果的数据有限，特别是比较心脏骤停并接受体外心肺复苏(ECPR)后撤除VA-ECMO的供体与心脏骤停未经ECPR的供体时。本研究旨在探讨ECPR后的器官捐献实践和结果，以提高我们对心脏骤停后捐献潜力的理解。

Methods: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor’s management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups.利用日本器官移植网络数据库的数据，对2010年7月17日至2022年8月31日期间所有死亡的器官捐献者进行全国回顾性队列研究。纳入至少经历过一次心脏骤停的捐献者。在研究期间，接受ECMO治疗的患者没有资格获得脑死亡的法律诊断。研究比较了ECPR组和非ECPR组之间与每个供体管理相关的时间框架和受体的长期移植结果。

Results: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death.共370例发生心脏骤停的脑死亡捐献者中，26例(7.0%)接受ECPR治疗，344例(93.0%)未接受 ECPR 治疗，多数为院外心脏骤停。ECPR后VA-ECMO的中位持续时间为3天。ECPR组患者从入院到器官获取的间隔时间明显长于未接受ECPR患者(13天比9天，p=0.005)。ECPR组的心脏捐献比例明显低于非ECPR组（50% vs. 80%，P<0.001）。ECPR组肺移植物存活率明显低于对照组(log-rank test p=0.009) ，其他器官移植物存活率差异无显著性。在160例发生心脏骤停的循环死亡捐献者中，27例(16.9%)接受ECPR 治疗，133例(83.1%)未接受ECPR治疗。从入院到循环死亡后器官采集的时间间隔和移植物存活率在ECPR组和非ECPR组之间没有显著差异。无论脑死亡或循环死亡，ECPR组和非ECPR组捐献的器官数量相似。

Conclusions: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation这项全国性的研究表明，ECPR治疗的捐献者的肺移植存活率较低，提示在ECPR后器官捐献中需要进行有针对性的研究和方案调整。