Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-08-08 DOI:10.1111/ctr.15422

Yeahwa Hong, Nidhi Iyanna, Nicholas R. Hess, Luke A. Ziegler, Mohamed Abdullah, Ander Dorken-Gallastegi, Michael A. Mathier, Mary E. Keebler, Gavin W. Hickey, David J. Kaczorowski

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Abstract

Background

This study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.

Methods

The UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist. The incidence of waitlist transfusion was compared before and after the 2018 allocation policy change. The primary outcome was survival. Propensity score-matching was performed. Multivariable logistic regression was performed to identify predictors of waitlist transfusion. A sub-analysis was performed to evaluate the impact of waitlist time on waitlist transfusion.

Results

From the 21 926 recipients analyzed in this study, 4201 (19.2%) received waitlist transfusion. The incidence of waitlist transfusion was lower following the allocation policy change (14.3% vs. 23.7%, p < 0.001). The recipients with waitlist transfusion had significantly reduced 1-year posttransplant survival (88.8% vs. 91.9%, p < 0.001) compared to the recipients without waitlist transfusion in an unmatched comparison. However, in a propensity score-matched comparison, the two groups had similar 1-year survival (90.0% vs. 90.4%, p = 0.656). Multivariable analysis identified ECMO, Impella, and pretransplant dialysis as strong predictors of waitlist transfusion. In a sub-analysis, the odds of waitlist transfusion increased nonlinearly with longer waitlist time.

Conclusion

There is a lower incidence of waitlist transfusion among transplant recipients under the 2018 allocation system. Waitlist transfusion is not an independent predictor of adverse posttransplant outcomes but rather a marker of the patient's clinical condition. ECMO, Impella, and pretransplant dialysis are strong predictors of waitlist transfusion.

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查看原文本刊更多论文

等待名单输血的演变趋势及其对心脏移植后受者预后的影响。

背景：本研究评估了临床趋势、风险因素以及等待输血对离体心脏移植术后结果的影响：本研究评估了临床趋势、风险因素以及等待名单输血对离体心脏移植术后预后的影响：方法：通过查询 UNOS 注册表，确定 2014 年 1 月 1 日至 2022 年 6 月 30 日期间的成年受者。根据受者在等待名单上是否输血，将其分为两组。比较了 2018 年分配政策变化前后等待输血的发生率。主要结果是存活率。进行了倾向评分匹配。进行了多变量逻辑回归，以确定等待输血的预测因素。还进行了一项子分析，以评估等待时间对等待输血的影响：在本研究分析的 21 926 名受者中，有 4201 人（19.2%）接受了候诊输血。分配政策改变后，等待输血的发生率降低了（14.3% 对 23.7%，P < 0.001）。在非配对比较中，与未进行等待输血的受者相比，进行了等待输血的受者移植后 1 年生存率明显降低（88.8% 对 91.9%，p < 0.001）。然而，在倾向得分匹配比较中，两组的 1 年生存率相似（90.0% 对 90.4%，p = 0.656）。多变量分析确定 ECMO、Impella 和移植前透析是候补名单输血的有力预测因素。在一项子分析中，等待输血的几率随着等待时间的延长而非线性增加：结论：在2018年分配制度下，移植受者等待输血的发生率较低。等待输血并非移植后不良结局的独立预测因素，而是患者临床状况的标志。ECMO、Impella和移植前透析是等待输血的有力预测因素。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.