Goldstein Benjamin A, Thomas Laine, Zaroff Jonathan G, Nguyen John, Menza Rebecca, Khush Kiran K
From the aDepartment of Biostatistics and Bioinformatics, Duke University, Durham, NC; bKaiser Northern California Division of Research, Oakland, CA; cDonor Network West, Oakland, CA; dGraduate School of Nursing, Midwifery, and Health, Victoria University of Wellington, Wellington, New Zealand; and eDivision of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
Epidemiology. 2016 Jul;27(4):469-76. doi: 10.1097/EDE.0000000000000472.
Over the past two decades, there have been increasingly long waiting times for heart transplantation. We studied the relationship between heart transplant waiting time and transplant failure (removal from the waitlist, pretransplant death, or death or graft failure within 1 year) to determine the risk that conservative donor heart acceptance practices confer in terms of increasing the risk of failure among patients awaiting transplantation.
We studied a cohort of 28,283 adults registered on the United Network for Organ Sharing heart transplant waiting list between 2000 and 2010. We used Kaplan-Meier methods with inverse probability censoring weights to examine the risk of transplant failure accumulated over time spent on the waiting list (pretransplant). In addition, we used transplant candidate blood type as an instrumental variable to assess the risk of transplant failure associated with increased wait time.
Our results show that those who wait longer for a transplant have greater odds of transplant failure. While on the waitlist, the greatest risk of failure is during the first 60 days. Doubling the amount of time on the waiting list was associated with a 10% (1.01, 1.20) increase in the odds of failure within 1 year after transplantation.
Our findings suggest a relationship between time spent on the waiting list and transplant failure, thereby supporting research aimed at defining adequate donor heart quality and acceptance standards for heart transplantation.
在过去二十年中，心脏移植的等待时间越来越长。我们研究了心脏移植等待时间与移植失败（从等待名单中移除、移植前死亡或移植后1年内死亡或移植物失败）之间的关系，以确定保守的供心接受标准在增加等待移植患者失败风险方面所带来的风险。
我们研究了2000年至2010年间在器官共享联合网络心脏移植等待名单上登记的28283名成年人队列。我们使用带有逆概率删失权重的Kaplan-Meier方法来检验在等待名单上（移植前）所花费时间累积的移植失败风险。此外，我们使用移植候选者血型作为工具变量来评估与等待时间增加相关的移植失败风险。
我们的结果表明，等待移植时间更长的人移植失败的几率更高。在等待名单上时，失败的最大风险发生在最初60天内。等待名单上的时间翻倍与移植后1年内失败几率增加10%（1.01，1.20）相关。
我们的研究结果表明等待名单上的时间与移植失败之间存在关联，从而支持旨在确定心脏移植合适的供心质量和接受标准的研究。
