Department of Surgery, Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas, USA.
Department of Surgery, Division of Abdominal Transplantation, Texas Children's Hospital, Houston, Texas, USA.
J Heart Lung Transplant. 2017 Nov;36(11):1201-1208. doi: 10.1016/j.healun.2017.04.010. Epub 2017 Apr 24.
Low case volume has been associated with lower survival after pediatric lung transplantation. Our aim was to analyze waitlist outcomes among pediatric lung transplant centers in the USA.
We studied a cohort of 1,139 pediatric candidates listed in the Organ Procurement and Transplantation Network for lung transplantation between 2002 and 2014. Of these candidates, 720 (63.2%) received a transplant. Candidates were divided into groups according to the clinical activity of the center of listing: high-volume pediatric (≥4 transplants per year); low-volume pediatric (<4 transplants per year); and adult (transplant volume predominantly in adults). We used multivariate Cox regression analysis to identify independent risk factors for waitlist mortality. We also determined the transplant rate-or likelihood of transplant after listing-over the study period.
Fifty-eight percent of the children and adolescents were listed in adult centers where the resultant transplant rate was low-only 42% received a transplant compared with 93% in pediatric programs. Listing in an adult program was also the most significant risk factor for death on the waiting list (hazard ratio 15.6, 95% confidence interval 5.8 to 42.1).
Most children (58%) are listed for lung transplantation in adult centers and have a reduced rate of transplantation and a greater chance of waitlist mortality.
小儿肺移植术后生存率与低病例量相关。本研究旨在分析美国小儿肺移植中心的等待名单结果。
我们研究了一个队列，该队列包括了 2002 年至 2014 年间在器官获取与移植网络登记接受肺移植的 1139 名小儿候选者。其中 720 名（63.2%）接受了移植。根据中心的临床活动，将候选者分为三组：高容量小儿（每年≥4 例移植）；低容量小儿（每年<4 例移植）；和成人（移植量主要在成人中）。我们使用多变量 Cox 回归分析来确定等待名单死亡率的独立危险因素。我们还确定了研究期间的移植率（或登记后移植的可能性）。
58%的儿童和青少年在成人中心登记，移植率较低，只有 42%接受了移植，而儿科项目的移植率为 93%。在成人中心登记也是等待名单上死亡的最显著危险因素（危险比 15.6，95%置信区间 5.8 至 42.1）。
大多数儿童（58%）在成人中心登记接受肺移植，其移植率较低，等待名单死亡率较高。
