Iribarne Alexander, Meltzer David O, Chauhan Dhaval, Sonett Joshua R, Gibbons Robert D, Vigneswaran Wickii, Russo Mark J
Department of Cardiothoracic Surgery, Dartmouth Medical Center, Hanover, NH, USA.
Center for Health and the Social Sciences (CHESS), University of Chicago, Chicago, IL, USA.
Clin Transplant. 2016 Jun;30(6):688-93. doi: 10.1111/ctr.12735. Epub 2016 Apr 15.
To evaluate the association between allocation of donor lungs by geographic sharing type (GST) and lung allocation score (LAS).
UNOS data included lung transplant recipients between 5/4/05 and 09/30/15 (n = 17 416) grouped by GST of donor lungs: local, regional, or national. Recipients were stratified by LAS <50, 50-75, and >75. Kaplan-Meier analysis was used to assess five-yr survival.
The majority of lungs were shared locally (n = 9200; 52.8%) followed by nationally (n = 5356; 30.8%) and regionally (n = 2860; 16.4%). There was a significant difference in the mean LAS at transplant (local: 43.7 ± 15; regional: 49.5 ± 18.8; national 51 ± 19.4; p < 0.001). There was a significant association between GST and LAS (p < 0.001). The majority (n = 7431; 58.2%) of recipients with LAS <50 received local lungs. Recipients with LAS >75 received a majority of their organs from national (n = 881; 45.4%) and regional (n = 414; 21.6%) donors. Although statistically significant (p = 0.024), absolute decline in five-yr survival by GST in the national GST was only 1.1% compared to the local GST.
Nearly half of all lungs in the United States are allocated locally to recipients with an LAS <50. Additional studies should determine if organ sharing over broader geographies would improve waitlist outcomes.
评估供肺按地理共享类型（GST）分配与肺分配评分（LAS）之间的关联。
器官共享联合网络（UNOS）的数据包括2005年5月4日至2015年9月30日期间的肺移植受者（n = 17416），按供肺的GST分组：本地、区域或全国。受者按LAS＜50、50 - 75和＞75进行分层。采用Kaplan - Meier分析评估5年生存率。
大多数肺在本地共享（n = 9200；52.8%），其次是全国共享（n = 5356；30.8%）和区域共享（n = 2860；16.4%）。移植时的平均LAS存在显著差异（本地：43.7±15；区域：49.5±18.8；全国51±19.4；p＜0.001）。GST与LAS之间存在显著关联（p＜0.001）。LAS＜50的受者大多数（n = 7431；58.2%）接受本地肺。LAS＞75的受者大多数器官来自全国（n = 881；45.4%）和区域（n = 414；21.6%）供者。尽管具有统计学意义（p = 0.024），但与本地GST相比，全国GST的5年生存率绝对下降仅为1.1%。
美国近一半的肺在本地分配给LAS＜50的受者。进一步研究应确定更广泛地理区域的器官共享是否会改善等待名单上的结果。
