Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania.
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2021 Feb;111(2):421-426. doi: 10.1016/j.athoracsur.2020.05.087. Epub 2020 Jul 11.
Extended criteria donor (ECD) for lung transplantation (LTx) have been implemented due to the donor organ shortage. The impact on recipient survival is under investigation. We report trends in the use of extended criteria lungs in the modern era and its association with survival outcomes using a large national database.
We performed a retrospective analysis of all adult LTx from May 2005 to December 2018 using the United Network for Organ Sharing database. ECD were defined by 2 or more variances from standard criteria: age ≥ 55 years, pO2 ≤ 300, pack years ≥ 20, diabetes, purulent bronchoscopy, blood infection, or abnormal chest radiographs. Transplant centers were dichotomized based on volume. Recipient survival was analyzed using lung allocation score as a covariate.
Of 24,888 LTx, 80% had extended criteria; 42% had 2 or more extensions and were deemed ECD in this analysis. Both LTx volume (2005: 1352; 2018: 2495) and use of ECD (2005: 27% ECD, 2018: 50% ECD) have increased over the study period. Survival of LTx recipients has steadily increased (2005: 82% 1-year survival in 2005; 2017: 90% 1-year survival). High-volume centers (>47 annual LTx) utilized ECD in 46% of transplants compared with 40% ECD among other centers. Recipients of ECD and standard criteria organs had no difference in 1-year survival.
Donor supply limits the number of LTx performed. Extension of donor criteria has occurred alongside increased overall LTx volume. Use of ECD did not compromise 30-day, 90-day, nor 1-year survival. Further studies are warranted to define long-term outcomes.
由于供体器官短缺，已经实施了延长标准供体（ECD）用于肺移植（LTx）。正在研究这对受者存活率的影响。我们使用大型国家数据库报告了现代时代扩展标准肺的使用趋势及其与生存结果的关联。
我们使用美国器官共享网络数据库对 2005 年 5 月至 2018 年 12 月期间的所有成人 LTx 进行了回顾性分析。ECD 的定义是标准标准有 2 个或更多变异：年龄≥55 岁，pO2≤300，包年≥20，糖尿病，脓性支气管镜检查，血感染或异常胸片。根据体积将移植中心分为两类。使用肺分配评分作为协变量分析受者存活率。
在 24888 例 LTx 中，80%为延长标准；在本分析中，42%有 2 个或更多扩展，被认为是 ECD。LTx 数量（2005 年：1352；2018 年：2495）和 ECD 的使用（2005 年：27%ECD，2018 年：50%ECD）在研究期间均有所增加。LTx 受者的存活率稳步提高（2005 年：2005 年 1 年生存率为 82%；2017 年：1 年生存率为 90%）。与其他中心相比，高容量中心（>47 例/年 LTx）在 46%的移植中使用了 ECD。ECD 和标准标准器官的受者在 1 年生存率上没有差异。
供体供应限制了 LTx 的数量。供体标准的扩展是伴随着整体 LTx 数量的增加而发生的。使用 ECD 并没有影响 30 天，90 天和 1 年的生存率。需要进一步的研究来定义长期结果。
