Characterizing Survival for Patients Supported With Inotropes After the 2018 Donor Allocation Restructuring: A UNOS Database Analysis

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-03-04 DOI:10.1111/ctr.70105

Christopher Pritting, Joshua Chen, Abdulmojeed Ekiyoyo, Eric Warner, Yevgeniy Brailovsky, Vakhtang Tchantchaleishvili, Indranee Rajapreyar

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引用次数: 0

Abstract

Background

We sought to characterize adaptive changes to the revised UNOS donor heart allocation policy in 2018 and estimate long-term survival trends for heart transplant (HTx) recipients with respect to inotropic support.

Methods

Patients listed for HTx between July 18, 2014, and July 18, 2016 (prepolicy revision) and between October 18, 2018, and October 18, 2020 (postpolicy revision) were identified from the UNOS database. Sub-analyses examined trends in device progression where patients listed on inotropes were later transplanted on inotropes and/or on extracorporeal membranous oxygenator (ECMO), durable left ventricular assist device (LVAD), temporary mechanical circulatory support (tMCS), or intra-aortic balloon pump (IABP). Survival data post-HTx were calculated and plotted.

Results

Overall, 3,189 patients were waitlisted (pre: 1,408; post: 1,781). Patient demographics differed only by cardiac output, mean PCWP, cigarette use, ventilatory support, and time on the waitlist. Policy revisions were associated with an increase in patients transplanted while supported with IABP (p < 0.01), tMCS (p < 0.01), and ECMO (p < 0.01). In contrast, postpolicy, fewer patients were transplanted while on inotropes (p < 0.01) or an LVAD (p < 0.01), and 57.4% patients progressed from inotropes to another form of support (27.4% prepolicy, p < 0.01). Additionally, waitlisted patients in the postpolicy period were more likely to be transplanted (pre: 78.9% vs. post: 89.8%, p < 0.01) and more likely to survive (mortality, pre: 26.9% vs. post: 19.1, p < 0.01).

Conclusions

Allocation policy revisions have contributed to increased utilization of temporary support (ECMO, tMCS, and IABP) and decreased utilization of others such as durable LVADs. Additionally, revisions have led to improved survival and increased transplantation for patients waitlisted on inotropes, yet similar survival for each individual form of temporary support.

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2018年供体分配重组后肌力支持患者的生存特征：UNOS数据库分析

背景：我们试图描述2018年修订后的UNOS供体心脏分配政策的适应性变化，并估计心脏移植（HTx）受者在肌力支持方面的长期生存趋势。方法从UNOS数据库中筛选2014年7月18日至2016年7月18日（政策修订前）和2018年10月18日至2020年10月18日（政策修订后）期间列入HTx的患者。亚分析检查了设备进展的趋势，在这些患者中，列于正性肌力药物组的患者后来移植了正性肌力药物和/或体外膜性氧合器（ECMO）、耐用左心室辅助装置（LVAD）、临时机械循环支持装置（tMCS）或主动脉内气囊泵（IABP）。计算并绘制htx后的生存数据。结果：总共有3189名患者在等待名单中(前期：1408名；帖子:1781)。患者人口统计数据仅在心输出量、平均PCWP、吸烟、呼吸支持和等待名单时间上存在差异。政策修订与IABP支持移植的患者增加有关(p <；0.01), tMCS (p <；0.01), ECMO (p <；0.01)。相比之下，政策实施后，使用肌力药物进行移植的患者较少(p <；0.01)或LVAD (p <；0.01)， 57.4%的患者从肌力药物转为其他形式的支持(政策前27.4%,p <；0.01)。此外，政策实施后的等待患者更有可能接受移植(政策实施前：78.9% vs.政策实施后：89.8%,p <；0.01)和更有可能存活(死亡率，治疗前：26.9% vs.治疗后：19.1,p <；0.01)。分配政策的修订增加了临时支持（ECMO、tMCS和IABP）的使用率，减少了其他支持（如耐用lvad）的使用率。此外，修订后的方案提高了等待使用肌力疗法的患者的生存率，增加了移植量，但每种临时支持形式的生存率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.