Laks Hillel, Marelli Daniel, Fonarow Gregg C, Hamilton Michele A, Ardehali Abbas, Moriguchi Jaime D, Bresson Jessica, Gjertson David, Kobashigawa Jon A
Heart Transplant Program, University of California, Los Angeles, Calif. 90095-1741, USA.
J Thorac Cardiovasc Surg. 2003 Jan;125(1):49-59. doi: 10.1067/mtc.2003.62.
An alternate (second) adult recipient list was used to match excluded potential recipients with nonstandard donor hearts that would otherwise be unused.
The only absolute criterion for entering the alternate recipient list was age: 65 years old before 1998 and 70 years old after that. Group I consisted of alternates who underwent transplantation, and group II consisted of 401 contemporaneous recipients. Hearts were first offered to regularly listed patients. At least one of the following donor risks accounted for allocation to an alternate: coronary artery disease, reused transplanted heart, high-risk behavior, hepatitis seropositivity, decreased left ventricular ejection fraction, high inotropic requirement, left ventricular hypertrophy, age older than 55 years plus another risk, and small donor with no other matches.
Of 102 alternates, 82 were listed were because of age. After a median wait of 107 days, 62 alternates underwent transplantation. Median alternate recipient age was 67 years (vs 54 years, P <.001). Median donor age was 45 years (vs 31 years, P <.001). Survival for alternates at 90 days was 82% (vs 91%, P =.04). Significant recipient predictors of early mortality on multivariable analysis (n = 463) were previous cardiac surgery (odds ratio 2.74, 95% confidence interval 1.37-5.48) and renal dysfunction (odds ratio 1.39, 1.10-176). Alternate listing did not independently predict early or late mortality. Late (>90 days) death rates per 1000 person-months were 4.3 and 3.6 for groups I and II (relative risk 1.2, 0.62-2.36).
Use of two adult recipient lists facilitated allocation of unused donor organs. Satisfactory long-term survival supports the use of an alternate recipient list.
使用备用（第二）成人受者名单，将被排除的潜在受者与否则将被弃用的非标准供体心脏进行匹配。
进入备用受者名单的唯一绝对标准是年龄：1998年以前为65岁，之后为70岁。第一组由接受移植的备用受者组成，第二组由401名同期受者组成。心脏首先提供给常规列出的患者。以下至少一项供体风险因素导致分配给备用受者：冠状动脉疾病、再次移植的心脏、高风险行为、肝炎血清学阳性、左心室射血分数降低、高强心剂需求、左心室肥厚、年龄超过55岁加另一风险因素，以及无其他匹配对象的小供体。
102名备用受者中，82名因年龄被列入名单。中位等待107天后，62名备用受者接受了移植。备用受者的中位年龄为67岁（相比之下，常规受者为54岁，P<.001）。供体的中位年龄为45岁（相比之下，常规供体为31岁，P<.001）。备用受者90天时的生存率为82%（相比之下，常规受者为91%，P=.04）。多变量分析（n=463）中早期死亡的显著受者预测因素为既往心脏手术（比值比2.74，95%置信区间1.37 - 5.48）和肾功能不全（比值比1.39，1.10 - 1.76）。列入备用名单并不能独立预测早期或晚期死亡。第一组和第二组每1000人月的晚期（>90天）死亡率分别为4.3和3.6（相对风险1.2，0.62 - 2.36）。
使用两个成人受者名单有助于未使用供体器官的分配。令人满意的长期生存率支持使用备用受者名单。
