Iris Feng, Paul A Kurlansky, Yanling Zhao, Krushang Patel, Morgan K Moroi, Alice V Vinogradsky, Farhana Latif, Gabriel Sayer, Nir Uriel, Yoshifumi Naka, Koji Takeda
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This study investigated outcomes of VA-ECLS patients bridged to simultaneous heart-kidney transplant (SHK) in the new policy era.</p><p><strong>Methods: </strong>This study included 774 adult patients from the UNOS database who received SHK between 10/18/18 and 12/31/21 and compared patients bridged to transplant on VA-ECLS (n = 50) with those not bridged (n = 724).</p><p><strong>Results: </strong>At baseline, SHK recipients bridged from VA-ECLS were younger (50.5 vs 58.0 years, p = 0.007), had higher estimated glomerular filtration rate (eGFR) at time of transplant (47.6 vs 30.1, p < 0.001), and spent fewer days on the waitlist (7.0 vs 33.5 days, p < 0.001). In the perioperative period, VA-ECLS was associated with higher rates of temporary dialysis (56.0% vs 28.0%, p < 0.001) but similar 2-year cumulative incidence of chronic dialysis (7.5% vs 5.4%, p = 0.800) and renal allograft failure (12.0% vs 8.1%, p = 0.500) compared to non-ECLS cohort. However, VA-ECLS patients had decreased survival to discharge (76.0% vs 92.7%, p < 0.001) and 2-year post-transplant survival (71.7% vs 83.0%, p = 0.004), as well as greater 2-year cumulative incidence of cardiac allograft failure (10.0% vs 2.7%, p = 0.002). Multivariable analyses found VA-ECLS at time of transplant to be independently associated with 2-year post-transplant mortality (HR [95% CI]: 3.40 [1.66-6.96], p = 0.001) and cardiac allograft failure (sub-distribution hazard ratio [SHR] [95% CI]: 8.51 [2.77-26.09], p < 0.001).</p><p><strong>Conclusion: </strong>Under the new allocation policy, patients bridged to SHK from VA-ECLS displayed greater early mortality and cardiac allograft failure but similar renal outcomes compared to non-ECLS counterparts.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":"11-21"},"PeriodicalIF":6.4000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bridge to simultaneous heart-kidney transplantation via extracorporeal life support: National outcomes in the new heart allocation policy era.\",\"authors\":\"Iris Feng, Paul A Kurlansky, Yanling Zhao, Krushang Patel, Morgan K Moroi, Alice V Vinogradsky, Farhana Latif, Gabriel Sayer, Nir Uriel, Yoshifumi Naka, Koji Takeda\",\"doi\":\"10.1016/j.healun.2024.08.020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Since United Network for Organ Sharing (UNOS) revised their heart allocation policy in 2018, usage of veno-arterial extracorporeal life support (VA-ECLS) has dramatically increased as a bridge to transplant. 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引用次数: 0
摘要
目的:自器官共享联合网络(UNOS)于 2018 年修订其心脏分配政策以来,静脉-动脉体外生命支持(VA-ECLS)作为移植桥梁的使用率急剧上升。本研究调查了新政策时代桥接至同步心肾移植(SHK)的VA-ECLS患者的预后:该研究纳入了 UNOS 数据库中 774 名在 18 年 10 月 18 日至 21 年 12 月 31 日期间接受 SHK 的成年患者,并对在 VA-ECLS 上桥接移植的患者(n=50)与未桥接移植的患者(n=724)进行了比较:结果:基线时,从VA-ECLS桥接的SHK受者更年轻(50.5岁 vs. 58.0岁,p=0.007),移植时的eGFR更高(47.6 vs. 30.1,pConclusion):在新的分配政策下,与非ECLS患者相比,从VA-ECLS桥接到SHK的患者显示出更高的早期死亡率和心脏异体移植失败率,但肾脏结果相似。
Bridge to simultaneous heart-kidney transplantation via extracorporeal life support: National outcomes in the new heart allocation policy era.
Background: Since United Network for Organ Sharing (UNOS) revised their heart allocation policy in 2018, usage of veno-arterial extracorporeal life support (VA-ECLS) has dramatically increased as a bridge to transplant. This study investigated outcomes of VA-ECLS patients bridged to simultaneous heart-kidney transplant (SHK) in the new policy era.
Methods: This study included 774 adult patients from the UNOS database who received SHK between 10/18/18 and 12/31/21 and compared patients bridged to transplant on VA-ECLS (n = 50) with those not bridged (n = 724).
Results: At baseline, SHK recipients bridged from VA-ECLS were younger (50.5 vs 58.0 years, p = 0.007), had higher estimated glomerular filtration rate (eGFR) at time of transplant (47.6 vs 30.1, p < 0.001), and spent fewer days on the waitlist (7.0 vs 33.5 days, p < 0.001). In the perioperative period, VA-ECLS was associated with higher rates of temporary dialysis (56.0% vs 28.0%, p < 0.001) but similar 2-year cumulative incidence of chronic dialysis (7.5% vs 5.4%, p = 0.800) and renal allograft failure (12.0% vs 8.1%, p = 0.500) compared to non-ECLS cohort. However, VA-ECLS patients had decreased survival to discharge (76.0% vs 92.7%, p < 0.001) and 2-year post-transplant survival (71.7% vs 83.0%, p = 0.004), as well as greater 2-year cumulative incidence of cardiac allograft failure (10.0% vs 2.7%, p = 0.002). Multivariable analyses found VA-ECLS at time of transplant to be independently associated with 2-year post-transplant mortality (HR [95% CI]: 3.40 [1.66-6.96], p = 0.001) and cardiac allograft failure (sub-distribution hazard ratio [SHR] [95% CI]: 8.51 [2.77-26.09], p < 0.001).
Conclusion: Under the new allocation policy, patients bridged to SHK from VA-ECLS displayed greater early mortality and cardiac allograft failure but similar renal outcomes compared to non-ECLS counterparts.
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.