Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Am J Transplant. 2018 Aug;18(8):2061-2067. doi: 10.1111/ajt.14885. Epub 2018 May 9.
Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. To investigate these issues, offer acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) were estimated using offers from donors recovered July 1, 2016, and June 30, 2017. Logistic regressions estimated the association of DSA-level offer acceptance ratios with donor yield and local placement of organs recovered in the DSA. Competing risk methodology estimated the association of program-level offer acceptance ratios with incidence and rate of waitlist removals due to death or becoming too sick to undergo transplant. Higher DSA-level offer acceptance was associated with higher yield (odds ratios [ORs]: lung, 1.11 ; heart, 1.21 ) and more local placement of transplanted organs (ORs: lung, 1.12 ; heart, 1.69 ). Higher program-level offer acceptance was associated with lower incidence of waitlist removal due to death or becoming too sick to undergo transplant (hazard ratios [HRs]: heart, 0.86 ; lung, 0.75 ), but not with rate of waitlist removal (HRs: heart, 0.98 ; lung, 0.99 ). Heart and lung offer acceptance practices affected numbers of transplanted organs and contributed to program-level variability in the probability of waitlist mortality.
心脏和肺脏供体接受情况的变化可能会影响移植器官的数量，并导致等待名单死亡率的差异。为了研究这些问题，使用 2016 年 7 月 1 日至 2017 年 6 月 30 日期间回收的供体的要约，分别估算了心脏和肺脏移植项目以及所有供体服务地区 (DSA) 内的移植项目的供体接受比率或调整后的优势比。逻辑回归估计了 DSA 级别的供体接受比率与供体收获量和在 DSA 中回收的器官的本地放置之间的关联。竞争风险方法估计了项目级别的供体接受比率与因死亡或病情太重而无法接受移植而导致的等待名单移除的发生率和比率之间的关联。较高的 DSA 级别供体接受率与较高的供体收获量（比值比 [ORs]：肺脏，1.11；心脏，1.21）和更多的移植器官本地放置（ORs：肺脏，1.12；心脏，1.69）相关。较高的项目级别的供体接受率与因死亡或病情太重而无法接受移植而导致的等待名单移除的发生率降低相关（风险比 [HRs]：心脏，0.86；肺脏，0.75），但与等待名单移除的比率无关（HRs：心脏，0.98；肺脏，0.99）。心脏和肺脏供体接受情况影响了移植器官的数量，并导致等待名单死亡率的项目级别差异。
