心脏移植等待名单上的存活率：连续流动左心室辅助装置作为移植桥的影响。
Survival on the heart transplant waiting list: impact of continuous flow left ventricular assist device as bridge to transplant.
机构信息
Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky.
Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky.
出版信息
Ann Thorac Surg. 2014 Sep;98(3):830-4. doi: 10.1016/j.athoracsur.2014.05.019. Epub 2014 Jul 31.
BACKGROUND
Continued donor organ shortage and improved outcomes with current left ventricular assist device (LVAD) technology have increased the number of patients supported with bridge-to-transplantation (BTT) therapy. Using the United Network of Organ Sharing (UNOS) database, we assessed the impact on survival in patients supported with BTT while on the heart transplant waiting list.
METHODS
The UNOS database was queried from January 2005 to June 2012 to identify patients listed for heart transplantation as UNOS status 1A or 1B. Patients implanted with a pulsatile-flow device or an LVAD other than the HeartMate II (HM II; Thoratec Inc, Pleasanton, CA) were excluded. Patients were divided into LVAD and non-LVAD groups based on status at the time of listing. Patients were propensity matched (LVAD -non-LVAD = 1:2) for age, sex, weight, presence of diabetes, creatinine levels, mean pulmonary artery pressure, and UNOS status. Kaplan-Meier curves were analyzed for survival.
RESULTS
A total of 8,688 patients were analyzed, with 1,504 (17%) in the LVAD group. Average age (52.6 ± 11.8 versus 51.3 ± 12.9 years; p = 0.0002) and weight (86.6 ± 18.6 versus 80.8 ± 18.2 kg; p < 0.0001) at time of listing were higher in the LVAD group. There were more men (79% versus 74%; p < 0.0001) and more patients with diabetes (30% versus 27%; p = 0.03) in the LVAD group. Of all patients, 6,943 patients (80%) underwent transplantation, 862 (10%) died, and 883 (10%) remained on the waiting list. After propensity matching, survival to transplantation was significantly better in the LVAD group than in the non-LVAD group at both 1 year (91% versus 77%) and 2 years (85% versus 68%).
CONCLUSIONS
Patients supported with an HM II LVAD as BTT therapy were older with increased comorbidities; they demonstrated an improved survival while listed for heart transplantation. The use of LVADs as a BTT strategy can potentially improve patient survival while waiting for transplantation and allow better allocation of donor hearts.
背景
随着目前左心室辅助装置（LVAD）技术的不断发展和供体器官短缺问题的持续存在，接受桥接移植（BTT）治疗的患者数量不断增加。利用美国器官共享网络（UNOS）数据库，我们评估了在心脏移植等待名单上接受 BTT 治疗的患者的生存情况。
方法
从 2005 年 1 月至 2012 年 6 月，对 UNOS 数据库进行了查询，以确定被列入心脏移植名单的 UNOS 状态 1A 或 1B 的患者。排除了植入搏动流装置或除 HeartMate II（HM II；Thoratec Inc，加利福尼亚州普莱森顿）以外的 LVAD 的患者。根据列入名单时的状态，将患者分为 LVAD 和非-LVAD 组。根据年龄、性别、体重、是否患有糖尿病、肌酐水平、平均肺动脉压和 UNOS 状态，对 LVAD-非-LVAD 患者进行倾向性匹配（1:2）。采用 Kaplan-Meier 曲线分析生存情况。
结果
共分析了 8688 例患者，其中 1504 例（17%）在 LVAD 组。LVAD 组患者的平均年龄（52.6±11.8 岁与 51.3±12.9 岁；p=0.0002）和体重（86.6±18.6 千克与 80.8±18.2 千克；p<0.0001）均高于非-LVAD 组。LVAD 组的男性比例更高（79%比 74%；p<0.0001），糖尿病患者比例更高（30%比 27%；p=0.03）。所有患者中，6943 例（80%）接受了移植，862 例（10%）死亡，883 例（10%）仍在等待名单上。在进行倾向性匹配后，LVAD 组患者的移植生存率在 1 年（91%比 77%）和 2 年（85%比 68%）时均明显高于非-LVAD 组。
结论
作为 BTT 治疗方法的 HM II LVAD 支持的患者年龄较大，合并症更多；他们在接受心脏移植的过程中，生存率得到了显著提高。将 LVAD 作为 BTT 策略使用可以在等待移植的过程中提高患者的生存机会，并能更好地分配供体心脏。
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