Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Transplantation. 2021 Sep 1;105(9):2080-2085. doi: 10.1097/TP.0000000000003514.
Pediatric donor heart acceptability differs among transplant centers. However, the impact of center donor acceptance on waitlist and posttransplant outcomes has not been investigated. The aim of our study was to investigate associations between transplant center refusal rate (RR) and outcomes after listing.
Retrospective analysis was performed using United Network for Organ Sharing/Organ Procurement and Transplant Network pediatric (<18 y) heart transplant data from 2007 to 2017. Center RR was defined as the median number of refusals per listed patient. Associations between RR center quartile and waitlist time, waitlist removal for death or clinical deterioration, posttransplant survival, and survival after listing were investigated.
There were 5552 listed patients in 59 centers who met inclusion criteria. The lowest quartile RR centers had a median RR of ≤1 per listed patient, and highest RR centers percentile had a median RR of ≥4. Highest RR centers had shorter time to first offer (19 versus 38 d; P < 0.001), with longer waitlist times (203 versus 145 d; P < 0.001), were more likely to remove patients from the waitlist due to death or deterioration (24.1% versus 14.6%; P < 0.001), less likely to transplant listed patients (63.1% versus 77.6%; P < 0.001), and had a lower likelihood of survival 1 year after listing (79.2% versus 91.6%; odds ratio, 1.6; 95% confidence interval, 1.2-2.0; P < 0.001) compared with low RR centers.
Patients listed at high RR centers had worse survival from listing despite having shorter times to first offer.
儿科供体心脏的可接受性在不同的移植中心之间存在差异。然而，中心供体接受程度对等待名单和移植后结果的影响尚未得到研究。我们的研究目的是调查移植中心拒绝率（RR）与列入名单后的结果之间的关联。
使用 2007 年至 2017 年美国器官共享联合网络/器官获取和移植网络儿科（<18 岁）心脏移植数据进行回顾性分析。中心 RR 定义为每例列入名单的患者拒绝的中位数。调查 RR 中心四分位数与等待名单时间、因死亡或临床恶化而从等待名单中移除、移植后生存率和列入名单后的生存率之间的关系。
59 个中心共有 5552 例符合入选标准的患者。RR 最低四分位中心的中位数 RR 为≤1 例/列入名单患者，RR 最高四分位中心的中位数 RR 为≥4 例/列入名单患者。RR 最高的中心首次获得供体的时间更短（19 天与 38 天；P<0.001），等待名单时间更长（203 天与 145 天；P<0.001），更有可能因死亡或恶化而将患者从等待名单中移除（24.1%与 14.6%；P<0.001），列入名单的患者接受移植的可能性较低（63.1%与 77.6%；P<0.001），列入名单 1 年后的生存率较低（79.2%与 91.6%；比值比，1.6；95%置信区间，1.2-2.0；P<0.001），与 RR 较低的中心相比。
尽管首次获得供体的时间更短，但在 RR 较高的中心列入名单的患者，从列入名单到死亡的存活率较差。
