United Network for Organ Sharing, Richmond, Virginia, USA.
Baylor University Medical Center, Member of Baylor Scott and White Health, Dallas, Texas, USA.
Am J Transplant. 2020 Oct;20(10):2781-2790. doi: 10.1111/ajt.16010. Epub 2020 Jun 14.
In 2018, the Organ Procurement and Transplantation Network (OPTN) modified adult heart allocation to better stratify candidates and provide broader access to the most medically urgent candidates. We analyzed OPTN data that included waiting list and transplant characteristics, geographical distribution, and early outcomes 1 year before (pre: October 18, 2017-October 17, 2018) and following (post: October 18, 2018-October 17, 2019) implementation. The number of adult heart transplants increased from 2954 pre- to 3032 postimplementation. Seventy-eight percent of transplants in the post era were for the most medically urgent (statuses 1-3) compared to 68% for status 1A in the pre era. The median distance between the donor hospital and transplant center increased from 83 to 216 nautical miles, with an increase in total ischemic time from 3 to 3.4 hours (all P < .001). Waiting list mortality was not different across eras (14.8 vs 14.9 deaths per 100 patient-years pre vs post respectively). Posttransplant patient survival was not different, 93.6% pre and 92.8% post. There is early evidence that the heart allocation policy has enhanced stratification of candidates by their medical urgency and broader distribution for the most medically urgent candidates with minimal impact on overall waiting list mortality and posttransplant outcomes.
2018 年，器官获取与移植网络（OPTN）修改了成人心脏分配方案，以更好地对候选者进行分层，并为最需要医疗的候选者提供更广泛的机会。我们分析了 OPTN 数据，其中包括等待名单和移植特征、地理分布以及实施前 1 年（前：2017 年 10 月 18 日-2018 年 10 月 17 日）和实施后 1 年（后：2018 年 10 月 18 日-2019 年 10 月 17 日）的数据。成人心脏移植数量从实施前的 2954 例增加到实施后的 3032 例。在后一时期，78%的移植是为最需要医疗的候选者（状态 1-3）进行的，而在前一时期，状态 1A 的移植比例为 68%。供体医院与移植中心之间的中位数距离从 83 海里增加到 216 海里，总缺血时间从 3 小时增加到 3.4 小时（均 P < 0.001）。两个时期的等待名单死亡率没有差异（分别为每 100 例患者年 14.8 例和 14.9 例死亡）。移植后患者生存率无差异，分别为 93.6%和 92.8%。有早期证据表明，心脏分配政策通过候选者的医疗紧急程度进行了更好的分层，并为最需要医疗的候选者提供了更广泛的分配机会，而对整体等待名单死亡率和移植后结果的影响最小。
