Haneya A, Haake N, Diez C, Puehler T, Cremer J, Schmid C, Hirt S W
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
Thorac Cardiovasc Surg. 2011 Mar;59(2):93-7. doi: 10.1055/s-0030-1250482. Epub 2011 Mar 9.
In 2000, the Eurotransplant Foundation changed the allocation criteria following the enactment of the German Transplantation Law (GTL). Our study investigated the impact of the new allocation system on outcomes after heart transplantation (HTx) in Germany.
We compared 2 cohorts of patients who underwent HTx at our institution in two different 3-year periods before (Group 1: 01/1995-12/1997) and after (Group 2: 01/2003-12/2005) implementation of the new system.
An increase in the ratio of HTx performed on an urgency basis was found in Group 2 (8.3 % vs. 87.2 %; P < 0.001). The median waiting time and the ischemia time were significantly lower in Group 1 ( P < 0.05). Postoperatively, the length of ICU stay was significantly higher in Group 2 ( P = 0.04).
The new allocation system decreased the proportion of local and regional organ harvesting. It generates a higher ischemia time without increasing the number of transplantations and without improving the clinical outcome after HTx. The severity of heart failure, rate of secondary organ impairment, and comorbidity is markedly elevated in patients waiting for HTx on HU.
2000年，欧洲移植基金会在德国移植法（GTL）颁布后更改了分配标准。我们的研究调查了新分配系统对德国心脏移植（HTx）术后结果的影响。
我们比较了在我们机构接受HTx的两组患者，这两组患者分别处于新系统实施前（第1组：1995年1月 - 1997年12月）和实施后（第2组：2003年1月 - 2005年12月）的两个不同的3年时间段。
第2组中紧急进行HTx的比例有所增加（8.3%对87.2%；P < 0.001）。第1组的中位等待时间和缺血时间显著更低（P < 0.05）。术后，第2组的重症监护病房停留时间显著更长（P = 0.04）。
新分配系统降低了本地和区域器官获取的比例。它在不增加移植数量且未改善HTx术后临床结果的情况下产生了更长的缺血时间。在因心力衰竭等待HTx的患者中，心力衰竭的严重程度、继发器官损害率和合并症显著升高。
