2018年新分配政策下远距离获取脑死亡供体的心脏移植

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-02-27 DOI:10.1111/ctr.70122

Rintaro Kinjo, Sooyun Caroline Tavolacci, Shazli Khan, Kenji Okumura, Junichi Shimamura, David Spielvogel, Suguru Ohira

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引用次数: 0

摘要

目的：关于长距离脑死亡供者（DBD）恢复的新心脏分配政策的结果数据有限。方法从2014年5月6日至2023年3月31日，查询美国器官共享网络（United Network for Organ Sharing）数据库，在22 806例离体心脏移植中，有1885例（8.3%）获得了超过500英里的供体心脏。根据政策改变前后（2018年10月18日）的移植日期将患者分为两组：旧（N = 443）和新（N = 1383）。采用倾向得分匹配法，共匹配439对。结果新系统ED心脏利用率提高2.7倍。配对前，不同的特征包括新组受者使用更多的临时机械循环支持装置和供者更多的缺氧作为死亡原因(新组47% vs旧组37%；p & lt;0.001)。在匹配的队列中，透析（14%对11%，p = 0.18）、卒中（3.9%对2.7%,p = 0.44）或起搏器植入（3.0%对2.5%,p = 0.83）的发生率相似。两组1年受体生存率（90.9% vs. 90.4%, p = 0.79）和移植物生存率（90.7% vs. 90.2%, p = 0.8）相似。结论在新的分配政策下，与政策改变前相比，ED心脏的利用率增加了约三倍，而不影响移植结果。

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Heart Transplantation Utilizing Brain-Dead Donors Procured From Extended Distances Under the 2018 New Allocation Policy

Purpose

There are limited data regarding outcomes of a new heart allocation policy on recovering brain-death donors (DBD) from extended distances.

Methods

From May 6, 2014, to March 31, 2023, the United Network for Organ Sharing database was queried where 1885 cases (8.3%) out of 22 806 isolated heart transplants received donor hearts from extended distances (ED) greater than 500 miles. Patients were divided into groups based on the transplanted date before or after the policy change (October 18, 2018): old (N = 443) versus new (N = 1383). A total of 439 pairs were matched utilizing propensity score matching.

Results

The utilization of hearts from ED in the new system increased 2.7 times. Before matching, characteristics that differed included new group recipients with higher usage of temporary mechanical circulatory support devices and donors with more anoxia as the cause of death (new, 47% vs. old, 37%; p < 0.001). In the matched cohort, the incidences of dialysis (14% vs. 11%, p = 0.18), stroke (3.9% vs. 2.7%, p = 0.44), or pacemaker implantation (3.0% vs. 2.5%, p = 0.83) were similar. Both groups showed similar 1-year recipient survival (90.9% vs. 90.4%, p = 0.79) and graft survival (90.7% vs. 90.2%, p = 0.8).

Conclusion

In the new allocation policy, the utilization of hearts from ED has increased approximately three-fold compared to the period before the policy change without affecting transplant outcomes.

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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.