心脏移植中哪些供体和受体危险因素重要？对五个国家53个中心的调查结果

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-06-19 DOI:10.1111/ctr.70214

Sabina P. W. Guenther, René Schramm, Jeffrey J. Teuteberg, Yasuhiro Shudo, Anna L. Rogge, Katharina E. Schaeper, Henrik Fox, Lisa Hoepner, Chawannuch Ruaengsri, Angelika Costard-Jaeckle, William Hiesinger, Y. Joseph Woo, Michiel Morshuis, Kiran K. Khush, Jan F. Gummert, Brian J. Wayda

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引用次数: 0

摘要

关于可接受的心脏移植供体或受体的定义缺乏共识。这项调查分析了风险因素如何指导捐赠者和接受者的选择，以及不同系统的做法如何不同。方法对美国和欧洲移植（ET）地区的成人HT中心进行在线调查。我们的目标是在这两个地区至少占成人HT总量的50%。中心按其HT体积分层。为了补偿无反应者，纳入了安全边际，并联系了至少占总HT体积75%的中心。中心被询问了连续危险因素的相对阈值和绝对截止值。对于其他因素，评估了它们对供体心脏接受度或列出受者可能性的影响。结果来自5个国家的53个中心参与：39个美国中心（占美国HT量的51.0%）和14个ET中心（占美国HT量的65.0%）。ET中心更开放地考虑高龄供体心脏(阈值64.5 [60.0-70.0]vs. 50.0[50.0 - 55.0]年，p <；0.001)，超声心动图或冠状动脉发现异常的心脏。四分之一到一半以上的美国和ET中心将糖尿病、吸烟和高血压列为中度或重度影响供体心脏接受度的因素。ET中心更自由地列出慢性肾脏疾病候选患者(GFR 30.0 [21.5-32.5] vs. 35.0 [30.0 - 40.0] mL/min/1.73m2, p <；0.001)。相反，美国中心允许更高的候选人年龄(71.5 [70.0-74.0]vs. 68.0[65.0-70.0]岁，p <；0.001)，并且更有可能（76.9%）列出ECMO支持的候选人（42.9%的ET中心不太可能列出，p = 0.022）。结论：选择实践在美国和英国之间有明显的不同。此外，实践似乎是由谨慎驱动的，比目前的指导方针更保守。加强证据基础，客观优化供体和候选人选择，有助于缓解供体心脏需求未得到满足的问题。

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Which Donor and Recipient Risk Factors Matter in Heart Transplantation? Results From a Survey of 53 Centers Across Five Countries

Introduction

Consensus regarding what defines acceptable heart transplant (HT) donors or recipients is lacking. This survey analyzed how risk factors guide donor and recipient selection, and how practices vary across systems.

Methods

An online survey was conducted among adult HT centers in the US and Eurotransplant (ET) region. We aimed to represent at least 50% of the total adult HT volumes in both regions. Centers were stratified by their HT volumes. To compensate for non-responders, a safety margin was included, and centers accounting for at least 75% of the total HT volumes were contacted. Centers were queried on relative thresholds and absolute cutoffs for continuous risk factors. For other factors, their influence on donor heart acceptance or the likelihood of listing recipients was assessed.

Results

Fifty-three centers from five countries participated: 39 US (accounting for 51.0% of the US HT volume), and 14 ET centers (65.0%) from four countries. ET centers more liberally considered advanced age donor hearts (threshold 64.5 [60.0–70.0] vs. 50.0 [50.0–55.0] years, p < 0.001), and hearts with abnormal echocardiography or coronary findings. Diabetes, smoking, and hypertension were rated by a quarter to more than half of US and ET centers as moderately or heavily influencing donor heart acceptance. ET centers more liberally listed candidates with chronic kidney disease (GFR 30.0 [21.5–32.5] vs. 35.0 [30.0–40.0] mL/min/1.73m², p < 0.001). US centers, conversely, allowed for higher candidate ages (71.5 [70.0–74.0] vs. 68.0 [65.0–70.0] years, p < 0.001), and more likely (76.9%) listed candidates on ECMO support (42.9% of ET centers to less likely list, p = 0.022).

Conclusion

Selection practices differed distinctly between the US and ET. Further, practices appear to be driven by caution and are more conservative than current guidelines. Strengthening the evidence base to objectify and optimize donor and candidate selection could help alleviate the unmet need for donor hearts.

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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.