Department of Cardiovascular and Thoracic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
Department of Cardiovascular and Thoracic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
J Heart Lung Transplant. 2018 Mar;37(3):349-357. doi: 10.1016/j.healun.2017.07.015. Epub 2017 Jul 19.
In this study we investigated modern, non-utilization rates of potential cardiac donors with left ventricular dysfunction (LVD) to clarify this phenomenon's magnitude and the impact of recent studies suggesting these organs can be safely transplanted.
Using the United Network for Organ Sharing transplant database, we reviewed all donors evaluated between January 1, 2007 and June 30, 2014. Exclusion criteria included lack of consent and age <13 or >59 years. The number of hearts not transplanted due to non-cardiac causes, structural disease, "other" (previous cardiac surgery, donation after cardiac death, etc.) and isolated LVD was determined and a covariates-adjusted Poisson regression model with robust standard errors was developed to estimate non-utilization relative risk (RR) with 95% confidence interval (CI) for LVD. Heart disposition for potential donor hearts was determined separately for 2 previous eras (1990 to 1999 and 2000 to 2006), and trends were evaluated.
There were 60,789 donors assessed. Of the 44,829 organs meeting the inclusion criteria, 15,654 (34.92%) were transplanted and 29,175 (65.08%) were not. Of the non-utilized hearts, 15,512 (34.60%) were declined for non-cardiac reasons, 1,051 (2.34%) for structural disease, 4,073 (9.09%) for "other" and 8,539 (19.05%) exclusively for LVD. Of this last category, 4,950 (11.04%) lacked documented evidence of LVD. Covariates-adjusted RR for non-utilization showed that, for every 10% increase in LV ejection fraction, the risk of non-utilization decreased by 20% (RR = 0.80, 95% CI 0.79 to 0.81). Analysis of era-effect demonstrated significantly decreased overall utilization of donor hearts, with increases in the number of hearts not transplanted across all categories over time (p < 0.001).
Roughly 20% of potential cardiac donors are excluded due to LVD. This figure has not been impacted by recent studies indicating that these hearts may be used safely. More complete data are required to understand why 11.04% of hearts that met inclusion criteria were refused for "poor function" without documented evidence.
本研究旨在调查左心室功能障碍（LVD）潜在心脏供体的现代非利用率，以明确这一现象的规模，并探讨最近的研究表明这些器官可以安全移植的影响。
利用美国器官共享网络移植数据库，我们回顾了 2007 年 1 月 1 日至 2014 年 6 月 30 日期间评估的所有供体。排除标准包括缺乏同意以及年龄<13 岁或>59 岁。确定因非心脏原因、结构性疾病、“其他”（先前的心脏手术、心脏死亡后捐献等）和孤立性 LVD 而未移植的心脏数量，并采用具有稳健标准误差的协变量调整泊松回归模型，估计 LVD 的相对非利用率（RR）及其 95%置信区间（CI）。为 2 个先前的时代（1990 年至 1999 年和 2000 年至 2006 年）分别确定潜在供体心脏的心脏处置情况，并评估趋势。
共评估了 60789 名供体。在符合纳入标准的 44829 个器官中，15654 个（34.92%）被移植，29175 个（65.08%）未被移植。在未使用的心脏中，15512 个（34.60%）因非心脏原因被拒绝，1051 个（2.34%）因结构性疾病被拒绝，4073 个（9.09%）因“其他”原因被拒绝，8539 个（19.05%）仅因 LVD 被拒绝。在最后一类中，有 4950 个（11.04%）没有记录到 LVD 的证据。调整协变量后的 RR 显示，LV 射血分数每增加 10%，非利用率的风险降低 20%（RR=0.80，95%CI 0.79 至 0.81）。对时代效应的分析表明，供体心脏的总体利用率显著下降，随着时间的推移，所有类别的未移植心脏数量都有所增加（p<0.001）。
大约 20%的潜在心脏供体因 LVD 而被排除在外。这一数字并未受到最近的研究的影响，这些研究表明这些心脏可能可以安全使用。需要更完整的数据来了解为什么有 11.04%符合纳入标准的心脏因“功能不佳”而未被记录的证据而被拒绝。
