vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2018-2-29-36vtio-880Research ArticleКлиническая трансплантологияClinical TransplantologyОПЫТ ТРАНСПЛАНТАЦИИ СЕРДЦА ОТ ДОНОРОВ С ФРАКЦИЕЙ ИЗГНАНИЯ ЛЕВОГО ЖЕЛУДОЧКА МЕНЕЕ 40%HEART TRANSPLANTATION FROM DONORS WITH LEFT VENTRICULAR EJECTION FRACTIONПопцовВ. Н.PoptsovV. N.

123182, Москва, ул. Щукинская, д. 1.

1, Shchukinskaya st., Moscow, 123182.

poptsov_vit@mail.ruЗахаревичВ. М.ZakharevichV. M.СпиринаЕ. А.SpirinaE. A.ХатуцкийВ. М.KhatutskiiV. M.КолосковаН. Н.KoloskovaN. N.ТюняеваИ. Ю.TunyaevaI. Yu.ПчельниковВ. В.PchelnikovV. V.УстинС. Ю.UstinS. Yu.МасютинС. А.MasyutinS. A.ВоронковВ. Ю.VoronkovV. Yu.ДогонашеваА. А.DogonaschevaA. A.АлиевЭ. З.AlievE. Z.ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России.РоссияV.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation.Russian FederationФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России.Russian Federation2018260620182022936Copyright © Попцов В.Н., Захаревич В.М., Спирина Е.А., Хатуцкий В.М., Колоскова Н.Н., Тюняева И.Ю., Пчельников В.В., Устин С.Ю., Масютин С.А., Воронков В.Ю., Догонашева А.А., Алиев Э.З., 20182018Попцов В.Н., Захаревич В.М., Спирина Е.А., Хатуцкий В.М., Колоскова Н.Н., Тюняева И.Ю., Пчельников В.В., Устин С.Ю., Масютин С.А., Воронков В.Ю., Догонашева А.А., Алиев Э.З.Poptsov V.N., Zakharevich V.M., Spirina E.A., Khatutskii V.M., Koloskova N.N., Tunyaeva I.Y., Pchelnikov V.V., Ustin S.Y., Masyutin S.A., Voronkov V.Y., Dogonascheva A.A., Aliev E.Z.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/880Введение

Введение. Отдельные центры успешно выполняют ТС от доноров со сниженной фракцией изгнания ЛЖ (ФИ ЛЖ). Цель исследования: оценка результативности ТС от доноров с ФИ ЛЖ <40%.

Материалы и методы

Материалы и методы. В исследование включили 18 реципиентов (14 мужчин и 4 женщины, возраст от 29 до 59 (42,9 ± 2,7) лет), которым была выполнена ТС от доноров с ФИ ЛЖ <40%. Неотложность выполнения ТС соответствовала 1А-B (n = 16) и 2 (n = 2) статуса UNOS. У 11 (55,6%) пациентов применили предтрансплантационную механическую поддержку кровообращения: периферическая вено-артериальная экстракорпоральная мембранная оксигенация (ВА ЭКМО).

Результаты исследования

Результаты исследования. Для ТС использовали сердца от доноров (13 мужчин и 5 женщин, возраст от 22 до 57 (39,1 ± 3,0) лет), причиной смерти которых явилось травматическое (n = 3) и нетравматическое (n = 15) повреждение головного мозга. Наибольшая за время наблюдения симпатомиметическая терапия – норадреналин 433 ± 46,2 нг/кг/мин (n = 14) и допамин 5,6 ± 2,5 мкг/кг/мин (n = 4). Лабораторные показатели крови сердечного донора: Нb 11,5 ± 0,7 г/л, общий белок 72 ± 14 г/л, натрий 139 ± 3 ммоль/л, тропонин I 0,3 ± 0,2 нг/мл, КФК МВ 98 ± 18 Ед./л. Данные ЭХОКГ-исследования сердечного донора: ФИ ЛЖ 22–39 (35,3 ± 4,3)%, диффузный гипокинез стенок ЛЖ (n = 10), локальные нарушения сократимости ЛЖ (n = 8). Продолжительность ишемии миокарда сердечного трансплантата составила 151 ± 27 мин. У 16 из 18 реципиентов наблюдали неосложненное течение послеоперационного периода. Продолжительность лечения в условиях ОРИТ составила 7,7 ± 1,3 суток. Все (100%) реципиенты сердца были выписаны из стационара.

Заключение

Заключение. Собственный опыт демонстрирует возможность результативного выполнения ТС от доноров с ФИ ЛЖ <40%. В большинстве наблюдений систолическая функция сердечного трансплантата нормализуется в ранний период после трансплантации сердца. 

Aim

Aim. Purpose of study was evaluated of early outcomes of HT performed from donors with LVEF <40%.

Materials and methods

Materials and methods. The study included 18 (14 men and 4 women, age 29 to 59 (42.9 ± 2.7) years) recipients who received cardiac allograft from donors with LVEF <40%. The urgency of HT was 1A-B (n = 16) and 2 status (n = 2) UNOS. 11 (55,6%) patients needed peripheral VA ECMO.

Results

Results. Heart donors (13 men and 5 women, 22 to 57 (39.1 ± 3) years) were the traumatic (n = 3) and non-traumatic (n = 15) brain damage. Maximal inotropic support was norepinephrine 433 ± 46.2 ng/kg /min (n = 14) and dopamine 5.6 ± 2.5 μg/kg/min (n = 4). Laboratory parameters of the heart donor blood: Hb 11.5 ± 0.7 g/l, total protein 72 ± 14 g/l, Na+ 139 ± 3 mmol/l, troponin I 0.3 ± 0.2 ng/ml, CK-MB 98 ± 18 U/l. ECG of the donor’s heart: LVEDV 134 ± 9 ml, LVEF 22–39 (35.3 ± 4.3)%, diffuse LV hypokinesis (n = 10), regional dyskinesis (n = 8). Ischemic time was 151 ± 27 min. 16 (88.9%) had acceptable cardiac allograft function. Primary graft failure treated by MCS (VAECMO (n = 2)) was in 2 (11.1%). ICU stay was 7.7 ± 1.2 days. All recipients were discharged at home.

Conclusions

Conclusions. Own experience demonstrates the satisfactory results of HT from donors with LVEF <40%. In more cases LV systolic function of cardiac allograft quickly normalized in early period after HT. 

трансплантация сердцанизкая фракция выброса левого желудочкаheart transplantationlow left ventricle ejection fractionReferencesDeo SV, Sung K, Daly RC et al. Cardiac transplantation after bridged therapy with continuous fl ow left ventricular assist devices. Heart. Lung. Circ. 2014; 23 (3): 224–228.Deo SV, Sung K, Daly RC et al. Cardiac transplantation after bridged therapy with continuous fl ow left ventricular assist devices. Heart. Lung. Circ. 2014; 23 (3): 224–228.Givens RC, Dardas T, Clerkin KJ et al. Outcomes of multiple listing for adult heart transplantation in the United States: analysis of OPTN data from 200 to 2013. JACC. 2015; 3 (12): 933–941.Givens RC, Dardas T, Clerkin KJ et al. Outcomes of multiple listing for adult heart transplantation in the United States: analysis of OPTN data from 200 to 2013. JACC. 2015; 3 (12): 933–941.Lima B, Rajagopal K, Petersen RP et al. Marginal cardiac allografts do not have increased primary graft dysfunction in alternate list transplantation. Circulation. 2006; 114: 127–132.Lima B, Rajagopal K, Petersen RP et al. Marginal cardiac allografts do not have increased primary graft dysfunction in alternate list transplantation. Circulation. 2006; 114: 127–132.Prieto D, Correia P, Baptista M, Antunes MJ. Outcome after heart transplantation from older donor age: expanding the donor pool. Eur. J. Cardiothorac. Surg. 2015; 47: 672–678.Prieto D, Correia P, Baptista M, Antunes MJ. Outcome after heart transplantation from older donor age: expanding the donor pool. Eur. J. Cardiothorac. Surg. 2015; 47: 672–678.Khush KK, Menza R, Nguyen J et al. Donor predictors of allograft use and recipients outcomes after heart transplantation. Circulation Heart. failure. 2013; 6: 300–309.Khush KK, Menza R, Nguyen J et al. Donor predictors of allograft use and recipients outcomes after heart transplantation. Circulation Heart. failure. 2013; 6: 300–309.Russo MJ, Davieas RR, Hong KN et al. Matching highrisk recipients with marginal donor hearts is a clinically effective strategy. Ann. Thorac. Surg. 2009; 87 (4): 1066–1070.Russo MJ, Davieas RR, Hong KN et al. Matching highrisk recipients with marginal donor hearts is a clinically effective strategy. Ann. Thorac. Surg. 2009; 87 (4): 1066–1070.Formi A, Luciani GB, Chiominto B et al. Results with expanding donor acceptance criteria in heart transplantation. Transplant. Proc. 2011; 43: 953–959.Formi A, Luciani GB, Chiominto B et al. Results with expanding donor acceptance criteria in heart transplantation. Transplant. Proc. 2011; 43: 953–959.Guglin M, Novotorova I. Neurogenic stunned myocardial and Takotsubo cardiomyopathy are the same syndrome: a pooled analysis. Congest. Heart. Fail. 2011; 17: 127–132.Guglin M, Novotorova I. Neurogenic stunned myocardial and Takotsubo cardiomyopathy are the same syndrome: a pooled analysis. Congest. Heart. Fail. 2011; 17: 127–132.Marechaux S, Fornes P, Petit S et al. Pathology of inverted Takotsubo cardiomyopathy. Cardiovasc. Pathol. 2008; 17: 241–243.Marechaux S, Fornes P, Petit S et al. Pathology of inverted Takotsubo cardiomyopathy. Cardiovasc. Pathol. 2008; 17: 241–243.Jeevanandam V, Fukukawa S, Prendergast TW et al. Standard criteria for an acceptable donor heart are restricting heart transplantation. Ann. Thorac. Surg. 1996; 62: 1268–1675.Jeevanandam V, Fukukawa S, Prendergast TW et al. Standard criteria for an acceptable donor heart are restricting heart transplantation. Ann. Thorac. Surg. 1996; 62: 1268–1675.Litz K, John R, Manchini DM et al. Outcomes in cardiac transplant recipients using allografts from older donor versus mortality on the transplant waiting lust: implications for donor selection criteria. J. Am. Coll. Cardiol. 2004; 43: 1553–1561.Litz K, John R, Manchini DM et al. Outcomes in cardiac transplant recipients using allografts from older donor versus mortality on the transplant waiting lust: implications for donor selection criteria. J. Am. Coll. Cardiol. 2004; 43: 1553–1561.D’Alessandro C, Golmard JL, Barreda L et al. Predictive risk factors for primary graft failure requiring temporary extra-corporeal membrane oxygenation support after cardiac transplantation in adults. Eur. J. Cardiothorac. Surg. 2011; 40 (4): 962–969.D’Alessandro C, Golmard JL, Barreda L et al. Predictive risk factors for primary graft failure requiring temporary extra-corporeal membrane oxygenation support after cardiac transplantation in adults. Eur. J. Cardiothorac. Surg. 2011; 40 (4): 962–969.Mohamedali B, Bhat G, Zelinger A. Frequency and pattern of left ventricular dysfunction in potential heart donors: implications regarding use of dysfunctional hearts for successful transplantation. J. Am. Coll. Cardiol. 2012; 60: 235–236.Mohamedali B, Bhat G, Zelinger A. Frequency and pattern of left ventricular dysfunction in potential heart donors: implications regarding use of dysfunctional hearts for successful transplantation. J. Am. Coll. Cardiol. 2012; 60: 235–236.Zaroff JG, Babcock WD, Shiboski SC et al. The impact of left ventricular dysfunction on cardiac donor transplant rate. J. Heart. Lung. Transplant. 2003; 22: 334– 337.Zaroff JG, Babcock WD, Shiboski SC et al. The impact of left ventricular dysfunction on cardiac donor transplant rate. J. Heart. Lung. Transplant. 2003; 22: 334– 337.Zaroff JG, Babcock WD, Shiboski SG et al. Temporal changes in left ventricular systolic function in hear donors: results of serial echocardiography. J. Heart. Lung. Transplant. 2003; 32: 383–388.Zaroff JG, Babcock WD, Shiboski SG et al. Temporal changes in left ventricular systolic function in hear donors: results of serial echocardiography. J. Heart. Lung. Transplant. 2003; 32: 383–388.Zaroff JG, Rordorf GA, Ogilvy CS et al. Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neutrally mediated cardiac injury. J. Am. Soc. Echocardiogr. 2000; 13: 774–779.Zaroff JG, Rordorf GA, Ogilvy CS et al. Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neutrally mediated cardiac injury. J. Am. Soc. Echocardiogr. 2000; 13: 774–779.Dujardin KS, McCully RB, Wijdics EF et al. Myocardial dysfunction associated with brain death: echocardiographic, and pathologic features. J. Heart. Lung. Transplant. 2001; 20: 350–357.Dujardin KS, McCully RB, Wijdics EF et al. Myocardial dysfunction associated with brain death: echocardiographic, and pathologic features. J. Heart. Lung. Transplant. 2001; 20: 350–357.Novitzy D, Rhodin J, Cooper DKC et al. Ultrastructure changes associated with brain death in human donor heart. Transpl. Int. 1997; 10: 24–32.Novitzy D, Rhodin J, Cooper DKC et al. Ultrastructure changes associated with brain death in human donor heart. Transpl. Int. 1997; 10: 24–32.Shivalkar B, Van Loon J, Wieland W et al. Variable effects of explosive or gradual increase of intracranial pressure on myocardial structure and function. Circulation. 1993; 87: 230–239.Shivalkar B, Van Loon J, Wieland W et al. Variable effects of explosive or gradual increase of intracranial pressure on myocardial structure and function. Circulation. 1993; 87: 230–239.Mohamedali B, Bhat G, Tatooles A, Zelinger A. Neurogenic stress cardiomyopathy in heart donors. J. Cardial. Fail. 2014; 20: 207–211.Mohamedali B, Bhat G, Tatooles A, Zelinger A. Neurogenic stress cardiomyopathy in heart donors. J. Cardial. Fail. 2014; 20: 207–211.Berman M, Ali A, Ashley E et al. Is stress cardiomyopathy the underlying cause of ventricular dysfunction associated with brain death. J. Heart. Lung. Transplant. 2010; 29: 957–965.Berman M, Ali A, Ashley E et al. Is stress cardiomyopathy the underlying cause of ventricular dysfunction associated with brain death. J. Heart. Lung. Transplant. 2010; 29: 957–965.Smiths JM, De Pauw M, De Vries E et al. Donor scoring system for heart transplantation and the impact on patients survival. J. Heart. Lung. Transplant. 2003; 334–337.Smiths JM, De Pauw M, De Vries E et al. Donor scoring system for heart transplantation and the impact on patients survival. J. Heart. Lung. Transplant. 2003; 334–337.Madan S, Patel SR, Saeed O et al. Prevalence, characteristics and prognostic impact of wall motion abnormalities in brain-dead cardiac donor with transient left ventricular systolic dysfunction (LVSD). J. Heart. Lung. Transplant. 2018: 37 (4S): S136–S137.Madan S, Patel SR, Saeed O et al. Prevalence, characteristics and prognostic impact of wall motion abnormalities in brain-dead cardiac donor with transient left ventricular systolic dysfunction (LVSD). J. Heart. Lung. Transplant. 2018: 37 (4S): S136–S137.Chen CW, Sprys MH, Gaffey AN et al. Low ejection fraction in donor hearts is not directly associated with increased recipient mortality. J. Heart. Lung. Transplant. 2017; 36: 611–615.Chen CW, Sprys MH, Gaffey AN et al. Low ejection fraction in donor hearts is not directly associated with increased recipient mortality. J. Heart. Lung. Transplant. 2017; 36: 611–615.Page A, Masser S, Large SR. Heart transplantation from donation after circulatory determined death. Ann. Cardio thorac. Surg. 2018; 7 (1): 75–81.Page A, Masser S, Large SR. Heart transplantation from donation after circulatory determined death. Ann. Cardio thorac. Surg. 2018; 7 (1): 75–81.

The authors declare that there are no conflicts of interest present.