Division of Thoracic & Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Va.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Va.
J Thorac Cardiovasc Surg. 2022 Jan;163(1):339-345. doi: 10.1016/j.jtcvs.2020.09.008. Epub 2020 Sep 6.
On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation.
Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras.
Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001).
Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status.
2017 年 11 月 24 日，器官获取与移植网络（Organ Procurement and Transplantation Network）实施了一项变更，用以捐赠者医院周围 250 海里（约 463 公里）的半径替代供体服务区来分配肺脏。我们旨在评估一个中小规模中心在实施后的经验。
从 2016 年 1 月至 2019 年 10 月，我们从机构数据库中确定了接受肺移植的患者（47 例在变更前，54 例在变更后）。对详细的图表进行回顾和机构成本数据的分析。采用单变量分析比较两个时期。
两组患者的短期死亡率和原发性移植物功能障碍无显著差异。实施后，本地捐赠减少（68%比 6%；P<0.001），旅行距离增加（145 英里比 235 英里；P=0.004），旅行费用（8626 美元比 14482 美元；P<0.001）和总采购成本（60852 美元比 69052 美元；P=0.001）也有所增加。我们还记录到实施后等待名单死亡率增加（每 100 名患者年 6.9 比 31.6；P<0.001）。
在一个中小规模中心实施新的分配政策后，一些变化符合政策意图。然而，出现了一些令人担忧的变化，包括等待名单死亡率增加和资源利用增加。继续对按规模和地理位置分层的移植中心进行密切监测，对于维持所有美国人都能获得肺移植的全球供应至关重要，无论他们的地理位置或社会经济地位如何。
