Evidence-Based Practice Research Program, Mayo Clinic, MN.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, MN.
Transplantation. 2019 Dec;103(12):2591-2601. doi: 10.1097/TP.0000000000002652.
This systematic review was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network (OPTN).
We identified 81 unique studies including 1 193 410 patients with median follow-up of 36 months posttransplant, reporting 108 unique risk factors.
Most risk factors (104) were recipient related; few (4) were donor related. Most risk factors were judged to be practical and feasible to routinely collect. Relative association measures were small to moderate for most risk factors (ranging between 1.0 and 2.0). The strongest relative association measure for a heart transplant outcome with a risk factor was 8.6 (recipient with the previous Fontan operation), for a kidney transplant 2.8 (sickle cell nephropathy as primary cause of end-stage renal disease), for a liver transplant 14.3 (recipient serum ferritin >500 µg/L), and for a lung transplant 6.3 (Burkholderia cepacia complex infection for 1 y or less). OPTN may consider some of these 108 variables for future collection to enhance transplant research and clinical care.
Evidence-based approaches can be used to determine variables collected in databases and registries. Several candidate variables have been identified for OPTN.
本系统评价旨在确定与移植结局相关的新变量，这些变量目前尚未被器官获取与移植网络（OPTN）收集。
我们共确定了 81 项独特的研究，其中包括 1193410 例中位随访时间为移植后 36 个月的患者，报告了 108 个独特的风险因素。
大多数风险因素（104 个）与受者相关；少数（4 个）与供者相关。大多数风险因素被认为是实用且可行的，可以常规收集。大多数风险因素的相对关联度量值较小到中等（范围在 1.0 到 2.0 之间）。与心脏移植结局相关的最强相对关联度量值为 8.6（先前接受过 Fontan 手术的受者），与肾脏移植相关的为 2.8（镰状细胞肾病作为终末期肾病的主要病因），与肝脏移植相关的为 14.3（受者血清铁蛋白>500 µg/L），与肺移植相关的为 6.3（定植于肺部的铜绿假单胞菌在 1 年或更短时间内）。OPTN 可能会考虑未来收集这些 108 个变量中的一些，以增强移植研究和临床护理。
可以使用循证方法来确定数据库和登记处中收集的变量。已经为 OPTN 确定了几个候选变量。
