Clinical Analysis Of 14 Cases Of Heart Transplantation From Donors After Brain Death (DBD)

Objective:This study aimed to analyze and summarize the prognosis of cardiac transplant receptors from donors after brain death (DBD) conducted in Shandong Provincial Qianfoshan Hospital and to prove the feasibility of the DBD heartMaterials and Methods:We retrospectively studied preoperative and postoperative information about diagnosis, treatment, and follow-up of 14 patients that accepted DBD heart transplantation. The patients were confined from August 2014 to March 2016 in Shandong Provincial Qianfoshan Hospital. All organs were allocated by the China Organ Transplant Response System. All organ donations and allograft procurements were conducted according to the national protocol.Results:Fourteen heart donors were studied; their ages were 33.7 years on average, and the male-female ratio was 12:2. Head trauma accounted for 9/14, stroke accounted for 2/14, anoxia accounted for 1/14, and tumor in the central nervous system accounted for 1/14. Three of these donor hearts were marginal grafts. In the 14 cases of heart transplantation from DBD, the average age of a receptor was 52.8±9.2 years old, and the male-female ratio was 9:5. The recipients were patients with dilated cardiomyopathy (10/14), coronary artery disease (3/14), and valvular disease (1/14). In terms of post-transplant complications, sputum test or urine cultures were positive in all 14 cases. A recipient was complicated with early allograft dysfunction; this recipient also had cardiac tamponade on the second day and Type B aortic dissection one month later after being supported by extracorporeal membrane oxygenation and intra-aortic balloon pump. Another recipient experienced hydrothorax, and in another, renal function returned to normal slowly. A breathing machine was used to bridge another patient to transplant. This man had tracheobronchial stenosis after surgery and was treated by tracheal stent placement through fiberoptic bronchoscopy. None of these complications resulted in patient death. The starting dose of immunosuppressant was determined according to the result of a genetic test. Immunosuppressant concentration was set within an expected limit according to trough concentration and peak concentration. No rejection occurred, and no recipient relapsed. One- and three-month patient survival rates were the same (100%), with a median follow-up of 11.1 (3-19) months.Conclusions:With careful donor selection, heart transplant from DBD can be performed safely and play a critical role in overcoming the extreme organ shortage in China. To achieve the best short-and long-term survival, mechanical circulatory support must be initiated promptly and appropriately. Gene analysis in patients may also help in selecting sensitive drugs to overcome drug resistance and thus improve treating effects.