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肺移植候选人的多重列表:一项队列研究。

Multiple listing in lung transplant candidates: A cohort study.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California.

Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California.

出版信息

Am J Transplant. 2019 Apr;19(4):1098-1108. doi: 10.1111/ajt.15124. Epub 2018 Oct 16.

Abstract

Lung transplant candidates can be waitlisted at more than one transplant center, a practice known as multiple listing. The factors associated with multiple listing and whether multiple listing modifies waitlist mortality or likelihood of lung transplant is unknown. US lung transplant waitlist candidates were identified as either single or multiple listed using data from the Scientific Registry of Transplant Recipients. Characteristics of single and multiple listed candidates were compared and multivariable logistic regression was used to estimate associations with multiple listing. Multiple listed candidates were matched to single listed candidates using a combination of exact and propensity score matching methods. Cox proportional hazard models were used to estimate the relationship of multiple listing on waitlist mortality and receiving a transplant. Multiple listing occurred in 2.3% of lung transplant waitlist candidates. Younger age, female gender, white race, short stature, high antibody sensitization, college or postcollege education, lower lung allocation score, and a cystic fibrosis diagnosis were independently associated with multiple listing. Multiple listing was associated with an increased likelihood of lung transplant (adjusted hazard ratio [aHR] 2.74, 95% CI 2.37 to 3.16) but was not associated with waitlist mortality (aHR 0.99, 95% CI 0.68 to 1.44).

摘要

肺移植候选人可以在多个移植中心进行候补,这种做法称为多名单。与多名单相关的因素以及多名单是否会改变候补死亡率或肺移植的可能性尚不清楚。使用来自移植受者科学登记处的数据,确定美国肺移植候补者是单一名单还是多名单。比较单一和多名单候选人的特征,并使用多变量逻辑回归估计与多名单相关的关联。使用精确和倾向评分匹配方法的组合,将多名单候选人与单一名单候选人相匹配。使用 Cox 比例风险模型估计多名单对候补死亡率和接受移植的关系。多名单发生在 2.3%的肺移植候补者中。年龄较小、女性、白种人、身材矮小、高抗体致敏、大学或大学后教育、较低的肺分配评分和囊性纤维化诊断与多名单独立相关。多名单与肺移植的可能性增加相关(调整后的危险比[aHR]2.74,95%CI 2.37 至 3.16),但与候补死亡率无关(aHR 0.99,95%CI 0.68 至 1.44)。

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