Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI.
Am J Transplant. 2016 Mar;16(3):930-7. doi: 10.1111/ajt.13507. Epub 2015 Nov 2.
US pediatric transplant candidates have limited access to lung transplant due to the small number of donors within current geographic boundaries, leading to assertions that the current lung allocation system does not adequately serve pediatric patients. We hypothesized that broader geographic sharing of pediatric (adolescent, 12-17 years; child, <12 years) donor lungs would increase pediatric candidate access to transplant. We used the thoracic simulated allocation model to simulate broader geographic sharing. Simulation 1 used current allocation rules. Simulation 2 offered adolescent donor lungs across a wider geographic area to adolescents. Simulation 3 offered child donor lungs across a wider geographic area to adolescents. Simulation 4 combined simulations 2 and 3. Simulation 5 prioritized adolescent donor lungs to children across a wider geographic area. Simulation 4 resulted in 461 adolescent transplants per 100 patient-years on the waiting list (range 417-542), compared with 206 (range 180-228) under current rules. Simulation 5 resulted in 388 adolescent transplants per 100 patient-years on the waiting list (range 348-418) and likely increased transplant rates for children. Adult transplant rates, waitlist mortality, and 1-year posttransplant mortality were not adversely affected. Broader geographic sharing of pediatric donor lungs may increase pediatric candidate access to lung transplant.
美国儿科移植候选人由于目前地理范围内供体数量有限，获得肺移植的机会有限，这导致人们断言当前的肺分配系统不能充分满足儿科患者的需求。我们假设更广泛的地理区域共享儿科（青少年，12-17 岁；儿童，<12 岁）供体肺将增加儿科候选者获得移植的机会。我们使用胸模拟分配模型来模拟更广泛的地理区域共享。模拟 1 使用当前的分配规则。模拟 2 将青少年供体肺在更广泛的地理区域内提供给青少年。模拟 3 将儿童供体肺在更广泛的地理区域内提供给青少年。模拟 4 将模拟 2 和 3 结合在一起。模拟 5 将青少年供体肺优先分配给更广泛地理区域内的儿童。模拟 4 导致等待名单上每 100 个患者年有 461 例青少年移植（范围为 417-542），而现行规则下为 206 例（范围为 180-228）。模拟 5 导致等待名单上每 100 个患者年有 388 例青少年移植（范围为 348-418），并且可能增加了儿童的移植率。成人移植率、等待名单死亡率和 1 年移植后死亡率没有受到不利影响。更广泛的儿科供体肺的地理区域共享可能会增加儿科候选者获得肺移植的机会。
