Trivedi Jaimin R, Rajagopal Keshava, Schumer Erin M, Birks Emma J, Lenneman Andrew, Cheng Allen, Slaughter Mark S
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Center for Advanced Heart Failure and Department of Cardiothoracic and Vascular Surgery, University of Texas - Houston McGovern Medical School, Houston, Texas.
Ann Thorac Surg. 2016 Nov;102(5):1512-1516. doi: 10.1016/j.athoracsur.2016.04.027. Epub 2016 Jun 18.
Heart transplantation remains the gold standard therapy for end-stage heart failure patients; however, volumes are limited because of donor organ shortage. With the increasing availability of more durable continuous flow left ventricular assist devices (CFLVADs), the matrix of the heart transplantation waiting list and that of donor allocation have seen substantial changes. We aimed to evaluate the impact of the stated reasons for status 1A at time of transplantation on post-transplantation survival in CFVAD patients.
The United Network of Organ Sharing (UNOS) thoracic organ transplantation database was queried between 2006 and 2013 to identify patients aged 18 years or older who underwent heart transplantation as UNOS status 1A. We further assessed the data to identify reasons for status 1A at time of transplantation in CFVAD patients. We also computed post-transplantation survival of patients supported with CFLVAD who were status 1A at the time of transplantation.
A total of 15,779 patients underwent heart transplantation during the study time period, of whom 8,429 were Status 1A, and 3,913 had CFLVAD at time of transplantation. Of all status 1A patients, 2,737 had CFLVAD at time of transplantation, of which 52% (1,413) had device complications (thrombosis, infection, malfunction, and other) and 48% (1,314) were on 30-day grace status 1A. Post-transplantation survival (at 3 years) of CFLVAD patients who received a transplant on 30-day grace status 1A was similar to patients who underwent transplantation on status 1B (84% versus 85%, p = 0.5), both of which were significantly better than status 1A patients because of device complications (84% and 85% versus 78%, p = 0.01) (Fig 1).
CFLVAD patients who underwent transplantation as Status 1B or on the 30-day grace Status 1A have similar post-transplantation survival. These data suggest that there needs to be an objective organ allocation system for recipients of heart transplant that prioritize patients with CFVAD complications and patients not eligible for CFVAD for transplantation over 30-day grace period patients.
心脏移植仍然是终末期心力衰竭患者的金标准治疗方法；然而，由于供体器官短缺，心脏移植的数量有限。随着更耐用的连续血流左心室辅助装置（CFLVADs）的可用性增加，心脏移植等待名单和供体分配的格局发生了重大变化。我们旨在评估移植时1A状态的所述原因对CFLVAD患者移植后生存的影响。
查询2006年至2013年器官共享联合网络（UNOS）胸器官移植数据库，以识别18岁及以上作为UNOS 1A状态接受心脏移植的患者。我们进一步评估数据，以确定CFLVAD患者移植时1A状态的原因。我们还计算了移植时为1A状态的接受CFLVAD支持的患者的移植后生存率。
在研究期间，共有15779例患者接受了心脏移植，其中8429例为1A状态，3913例在移植时有CFLVAD。在所有1A状态的患者中，2737例在移植时有CFLVAD，其中52%（1413例）有装置并发症（血栓形成、感染、故障和其他），48%（1314例）处于30天宽限期1A状态。在30天宽限期1A状态下接受移植的CFLVAD患者的移植后生存率（3年时）与1B状态下接受移植的患者相似（84%对85%，p = 0.5），这两者均显著优于因装置并发症而处于1A状态的患者（84%和85%对78%，p = 0.01）（图1）。
以1B状态或30天宽限期1A状态接受移植的CFLVAD患者具有相似的移植后生存率。这些数据表明，需要有一个客观的心脏移植受者器官分配系统，该系统应优先考虑有CFLVAD并发症的患者和不符合CFLVAD移植资格的患者，而不是处于30天宽限期的患者。
