Medical Scientist Training Program, Oregon Health & Science University, Portland, OR.
Department of Medicine, Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, OR.
J Am Coll Surg. 2020 Sep;231(3):351-360.e5. doi: 10.1016/j.jamcollsurg.2020.05.025. Epub 2020 Jun 17.
Current risk-adjusted models used to predict donor heart use and cardiac graft survival from organ donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart use and graft survival to better understand the relationship between donor management and transplantation outcomes.
We conducted a prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at 3 standardized time points during donor management. The primary outcomes measures were donor heart use and cardiac graft survival.
From 3,433 DBDs, 1,134 hearts (33%) were transplanted and 969 cardiac grafts (85%) survived after 684 ± 392 days of follow-up. After multivariable analysis, independent positive predictors of heart use included standard criteria donor status (odds ratio [OR] 3.93), male sex (OR 1.68), ejection fraction > 50% (OR 1.64), and partial pressure of oxygen to fraction of inspired oxygen ratio > 300 (OR 1.31). Independent negative predictors of heart use included donor age (OR 0.94), BMI > 30 kg/m (OR 0.78), serum creatinine (OR 0.83), and use of thyroid hormone (OR 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR 1.04 per μg/h).
Modifiable critical care parameters and treatments predict donor heart use and cardiac graft survival. The discordant relationship between thyroid hormone and donor heart use (negative predictor) vs cardiac graft survival (positive predictor) warrants additional investigation.
目前用于预测脑死亡（DBD）器官供者心脏使用率和心脏移植物存活率的风险调整模型不包括床边重症监护数据。我们试图确定心脏使用率和移植物存活率的新的独立预测因素，以更好地了解供者管理与移植结局之间的关系。
我们进行了一项前瞻性观察性研究，研究对象为 2008 年至 2013 年间由 10 个器官采购组织管理的 DBD。在供者管理的 3 个标准化时间点记录人口统计学数据、重症监护参数和治疗。主要结局指标为供者心脏使用率和心脏移植物存活率。
从 3433 例 DBD 中，1134 例（33%）心脏被移植，969 例（85%）心脏移植物在 684±392 天的随访后存活。多变量分析后，心脏使用率的独立正预测因素包括标准标准供者状态（比值比[OR]3.93）、男性（OR1.68）、射血分数>50%（OR1.64）和氧分压与吸入氧分数比值>300（OR1.31）。心脏使用率的独立负预测因素包括供者年龄（OR0.94）、BMI>30kg/m（OR0.78）、血清肌酐（OR0.83）和甲状腺激素的使用（OR0.78）。至于移植物存活率，在控制已知受者风险因素后，甲状腺激素剂量是唯一的独立预测因素（每μg/h 增加 1.04）。
可调节的重症监护参数和治疗方法可预测供者心脏使用率和心脏移植物存活率。甲状腺激素与供者心脏使用率（负预测因素）与心脏移植物存活率（正预测因素）之间的不和谐关系需要进一步研究。
