Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Division of Pediatric Cardiothoracic Surgery, University of Pittsburgh Medical Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Transplantation. 2021 Mar 1;105(3):620-627. doi: 10.1097/TP.0000000000003262.
Donors with drowning or asphyxiation (DA) as a mechanism of death (MOD) are considered high risk in pediatric lung transplantation. We sought to evaluate whether recipients of DA donors had negatively impacted outcomes.
Pediatric recipients recorded in the United Network for Organ Sharing registry between 2000 and 2019 were included. Primary stratification was donor MOD. Propensity matching with a 1:1 ratio was performed to balance the DA and non-DA MOD donor cohorts. Cox multivariable regression was used to determine the risk-adjusted impact of donor MOD. A subanalysis of the effect of lung allocation score was also evaluated.
A total of 1016 patients underwent bilateral lung transplantation during the study period, including 888 (85.6%) from non-DA donors and 128 (14.4%) from DA donors. Survival at 90 days, 1 year, and 2 years were similar in the matched and unmatched cohorts regardless of the donor MOD. Moreover, separate risk-adjusted analysis of drowning and asphyxiated donors was similar to other MOD donors at 30 days, 1 year, and 5 years. Similar survival findings persisted regardless of pretransplant lung allocation score. Although the rates of posttransplant stroke (1.0% versus 3.1%, P = 0.04) and the length of hospital stay (19 versus 22 d, P = 0.004) were elevated in the unmatched DA MOD recipients, these differences were mitigated after propensity matching.
This study evaluated the impact of DA MOD donors in pediatric lung transplant recipients and found similar rates of complications and survival in a propensity-matched cohort. These data collectively support the consideration of DA MOD donors for use in pediatric lung transplantation.
作为死亡机制（MOD）的溺水或窒息（DA）供体被认为是儿科肺移植的高风险供体。我们旨在评估接受 DA 供体的受者是否对结局产生负面影响。
纳入了 2000 年至 2019 年期间在美国器官共享网络登记的儿科受者。主要分层为供体 MOD。通过 1:1 比例的倾向匹配来平衡 DA 和非 DA MOD 供体队列。使用 Cox 多变量回归来确定供体 MOD 的风险调整影响。还评估了肺分配评分的效果的亚分析。
在研究期间，共有 1016 例患者接受了双侧肺移植，其中 888 例（85.6%）来自非 DA 供体，128 例（14.4%）来自 DA 供体。在匹配和不匹配的队列中，无论供体 MOD 如何，90 天、1 年和 2 年的生存率相似。此外，对溺水和窒息供体进行单独的风险调整分析，在 30 天、1 年和 5 年时与其他 MOD 供体相似。无论移植前肺分配评分如何，相似的生存结果均持续存在。尽管未匹配的 DA MOD 受者的移植后中风发生率（1.0%对 3.1%，P = 0.04）和住院时间（19 对 22 d，P = 0.004）较高，但在进行倾向匹配后，这些差异得到了缓解。
本研究评估了 DA MOD 供体对儿科肺移植受者的影响，并在倾向匹配的队列中发现了相似的并发症和生存率。这些数据共同支持考虑将 DA MOD 供体用于儿科肺移植。
