Hess Nicholas R, Hickey Gavin W, Sultan Ibrahim, Kilic Arman
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2020 Oct 14. doi: 10.1111/jocs.15118.
This study compared outcomes of patients bridged with extracorporeal membrane oxygenation (ECMO) to orthotopic heart transplantation (OHT) following the recent heart allocation policy change.
The United Network of Organ Sharing Registry (UNOS) database was queried to examine OHT patients between 2010 and 2020 that were bridged with ECMO. Waitlist outcomes and 1-year posttransplant survival were compared between patients waitlisted and/or transplanted before and after the heart allocation policy change. Secondary outcomes included posttransplant stroke, renal failure, and 1-year rejection.
A total of 285 waitlisted patients were included, 173 (60.7%) waitlisted under the old policy and 112 (39.3%) under the new policy. New policy patients were more likely to receive OHT (82.2% vs. 40.6%), and less likely to be removed from the waitlist due to death or clinical deterioration (15.0% vs. 41.3%; both p < .001). A total of 165 patients bridged from ECMO to OHT were analyzed, 72 (43.6%) transplanted during the old policy and 93 (56.3%) under the new. Median waitlist time was reduced under the new policy (4 days [interquartile range {IQR}: 2-6] vs. 47 days [IQR: 10-228]). Postoperative renal failure was higher in the new policy group (23% vs. 6%; p = .002), but rates of stroke and 1-year acute rejection were equivalent. One-year survival was lower the new policy but was not significant (79.8% vs. 90.3%; p = .3917).
The UNOS heart allocation policy change has resulted in decreased waitlist times and higher likelihood of transplant in patients supported with ECMO. Posttransplant 1-year survival has remained comparable although absolute rates are lower.
本研究比较了在近期心脏分配政策改变后，接受体外膜肺氧合（ECMO）过渡至原位心脏移植（OHT）的患者的结局。
查询器官共享联合网络登记处（UNOS）数据库，以研究2010年至2020年间接受ECMO过渡的OHT患者。比较了心脏分配政策改变前后列入候补名单和/或接受移植的患者的候补名单结局和移植后1年生存率。次要结局包括移植后中风、肾衰竭和1年排斥反应。
共纳入285名列入候补名单的患者，173名（60.7%）在旧政策下列入候补名单，112名（39.3%）在新政策下列入候补名单。新政策患者接受OHT的可能性更高（82.2%对40.6%），因死亡或临床恶化而从候补名单中移除的可能性更低（15.0%对41.3%；均p<0.001）。共分析了165名从ECMO过渡至OHT的患者，72名（43.6%）在旧政策期间接受移植，93名（56.3%）在新政策下接受移植。新政策下候补名单的中位时间缩短（4天[四分位间距{IQR}：2 - 6]对47天[IQR：10 - 228]）。新政策组术后肾衰竭发生率更高（23%对6%；p = 0.002），但中风和1年急性排斥反应发生率相当。新政策下1年生存率较低，但无统计学意义（79.8%对90.3%；p = 0.3917）。
UNOS心脏分配政策的改变导致接受ECMO支持的患者候补名单时间缩短，移植可能性增加。尽管绝对生存率较低，但移植后1年生存率仍相当。
