Feingold B, Webber S A, Bryce C L, Park S Y, Tomko H E, Comer D M, Mahle W T, Smith K J
Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA; Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Am J Transplant. 2015 Feb;15(2):427-35. doi: 10.1111/ajt.13071.
Allosensitized children who require a negative prospective crossmatch have a high risk of death awaiting heart transplantation. Accepting the first suitable organ offer, regardless of the possibility of a positive crossmatch, would improve waitlist outcomes but it is unclear whether it would result in improved survival at all times after listing, including posttransplant. We created a Markov decision model to compare survival after listing with a requirement for a negative prospective donor cell crossmatch (WAIT) versus acceptance of the first suitable offer (TAKE). Model parameters were derived from registry data on status 1A (highest urgency) pediatric heart transplant listings. We assumed no possibility of a positive crossmatch in the WAIT strategy and a base-case probability of a positive crossmatch in the TAKE strategy of 47%, as estimated from cohort data. Under base-case assumptions, TAKE showed an incremental survival benefit of 1.4 years over WAIT. In multiple sensitivity analyses, including variation of the probability of a positive crossmatch from 10% to 100%, TAKE was consistently favored. While model input data were less well suited to comparing survival when awaiting transplantation across a negative virtual crossmatch, our analysis suggests that taking the first suitable organ offer under these circumstances is also favored.
需要阴性前瞻性交叉配型的致敏儿童在等待心脏移植期间有很高的死亡风险。接受第一个合适的器官供体，无论交叉配型呈阳性的可能性如何，都将改善等待名单上的结果，但尚不清楚这是否会在登记后的所有时间，包括移植后，提高生存率。我们创建了一个马尔可夫决策模型，以比较在需要阴性前瞻性供体细胞交叉配型（等待）与接受第一个合适供体（接受）的情况下登记后的生存率。模型参数来自1A状态（最高紧急程度）小儿心脏移植登记的注册表数据。我们假设在等待策略中交叉配型呈阳性的可能性为零，并根据队列数据估计，在接受策略中交叉配型呈阳性的基本概率为47%。在基本情况假设下，接受策略显示出比等待策略增加了1.4年的生存益处。在多项敏感性分析中，包括将交叉配型呈阳性的概率从10%变化到100%，接受策略始终更受青睐。虽然模型输入数据不太适合比较在等待阴性虚拟交叉配型移植时的生存率，但我们的分析表明，在这些情况下接受第一个合适器官供体也更受青睐。
