先天性心脏病成人扩大标准捐献者的使用情况和结果。

IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

背景:心脏移植中循环死亡后捐献(DCD)和丙型肝炎病毒(HCV)阳性捐献者的使用增加了捐献者库。鉴于成人先天性心脏病(ACHD)人群的候选结果不佳,我们调查了与是否愿意考虑DCD和HCV+供体相关的候选结果,以及这些候选者接受HCV+和DCD移植后的移植结果:利用器官共享联合网络数据库,我们确定了分别在 01/01/2016-09/30/2023 期间(HCV 分析)和 12/01/2019-09/30/2023 期间(DCD 分析)上市或移植的成年 ACHD 候选者和受者。在候选者中,我们比较了移植的累积发生率,并将等待名单中的死亡/病情恶化作为竞争风险,按是否愿意考虑 HCV+ 和 DCD 提议进行比较。在HCV+(与HCV-)和DCD(与脑死亡[DBD])移植的受者中,我们比较了围手术期结果和移植后存活率:在 2016 年 1 月 1 日至 2023 年 9 月 30 日的 1436 名 ACHD 候选人中,37.0% 愿意考虑提供 HCV+ 心脏。在2019/01/12-09/30/2023的886名ACHD候选人中,15.5%愿意考虑DCD提议。经调整分析,愿意考虑HCV+报价与移植可能性增加84%相关,愿意考虑DCD报价与移植可能性增加56%相关。在 2016 年 1 月 1 日至 2023 年 9 月 30 日期间进行的 904 例移植中,6.4% 使用了 HCV+ 供体;在 2019 年 1 月 12 日至 2023 年 9 月 30 日期间进行的 540 例移植中,6.9% 使用了 DCD 供体。HCV+(与HCV-)和DCD(与DBD)心脏移植受者的围手术期结果和1年存活率相似:结论:与接受HCV-和DBD器官移植的受者相比,愿意考虑HCV+和DCD供体的ACHD候选者更有可能接受移植,且移植后的效果相似。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Utilization and outcomes of expanded criteria donors in adults with congenital heart disease

Background

Use of donation after circulatory death (DCD) and hepatitis C virus (HCV) positive donors in heart transplantation have increased the donor pool. Given poor waitlist outcomes in the adult congenital heart disease (ACHD) population, we investigated waitlist outcomes associated with willingness to consider DCD and HCV+ offers and post-transplant outcomes following HCV+ and DCD transplantation for these candidates.

Methods

Using the United Network for Organ Sharing database, we identified adult ACHD candidates and recipients listed or transplanted, respectively, between 01/01/2016 and 09/30/2023 for the HCV analysis and between 12/01/2019 and 09/30/2023 for the DCD analysis. Among candidates, we compared the cumulative incidence of transplant, with waitlist death/deterioration as a competing risk, by willingness to consider HCV+ and DCD offers. Among recipients of HCV+ (vs HCV-) and DCD (vs brain death [DBD]) transplants, we compared perioperative outcomes and post-transplant survival.

Results

Of 1,436 ACHD candidates from 01/01/2016 to 09/30/2023, 37.0% were willing to consider HCV+ heart offers. Of 886 ACHD candidates from 12/01/2019 to 09/30/2023, 15.5% were willing to consider DCD offers. On adjusted analysis, willingness to consider HCV+ offers was associated with 84% increased likelihood of transplant, and willingness to consider DCD offers was associated with 56% increased likelihood of transplant. Of 904 transplants between 01/01/2016 and 09/30/2023, 6.4% utilized HCV+ donors, and of 540 transplants between 12/01/2019 and 09/30/2023, 6.9% utilized DCD donors. Recipients of HCV+ (vs HCV-) and DCD (vs DBD) heart transplants had similar likelihood of perioperative outcomes and 1-year survival.

Conclusions

ACHD candidates who were willing to consider HCV+ and DCD offers were more likely to be transplanted and had similar post-transplant outcomes compared to recipients of HCV- and DBD organs.

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来源期刊
CiteScore
10.10
自引率
6.70%
发文量
1667
审稿时长
69 days
期刊介绍: The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.
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