Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Surg Res. 2021 Mar;259:106-113. doi: 10.1016/j.jss.2020.11.036. Epub 2020 Dec 3.
The data that exists regarding multiorgan procurement outcomes is conflicted. Given the increasing demand for pulmonary allografts, it is critical to assess the impact of dual procurement on lung transplant recipient outcomes.
The United Network for Organ Sharing transplant registry was queried for all first-time adult (age ≥18) lung transplant recipients between 2006 and 2018 and stratified by concurrent heart donor status. Multiorgan transplant recipients and recipients with missing survival time were excluded. Donors were excluded if they were donating after circulatory death, did not consent or were not approached for heart donation, the heart was recovered for nontransplant purposes, or the heart was recovered for transplant but not transplanted. Post-transplant survival was analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards regression.
A total of 18,641 recipients met inclusion criteria, including 6230 (33.4%) in the nonheart donor group (NHD) and 12,409 (66.6%) in the heart donor group (HD). HD recipients demonstrated longer survival at 10 years posttransplant, with a median survival of 6.5 years as compared with 5.9 years in NHD recipients. On adjusted analysis, HD and NHD recipients demonstrated comparable survival (AHR 0.95, 95% CI 0.90-1.01).
Concomitant heart and lung procurement was not associated with worse survival. This finding encourages maximizing the number of organs procured from each donor, particularly in the setting of urgency-driven thoracic transplantation.
目前关于多器官获取结果的数据存在冲突。鉴于对肺供体的需求不断增加，评估双器官获取对肺移植受者结局的影响至关重要。
本研究在美国器官共享联合网络移植登记处检索了 2006 年至 2018 年间所有首次接受成人（年龄≥18 岁）肺移植的患者，并根据同期心脏供体状态进行分层。排除多器官移植受者和生存时间缺失的受者。如果供者是在循环死亡后捐献的、不同意或未被邀请进行心脏捐献、心脏被用于非移植目的回收、或心脏被回收但未用于移植，则排除供者。使用 Kaplan-Meier 方法和多变量 Cox 比例风险回归分析移植后生存情况。
共有 18641 名受者符合纳入标准，其中非心脏供体组（NHD）6230 名（33.4%），心脏供体组（HD）12409 名（66.6%）。HD 受者在移植后 10 年的生存率更高，中位生存率为 6.5 年，而 NHD 受者为 5.9 年。调整分析显示，HD 和 NHD 受者的生存率相当（AHR 0.95，95%CI 0.90-1.01）。
同时进行心脏和肺获取与生存率降低无关。这一发现鼓励从每个供者中最大限度地获取器官，特别是在紧急情况下进行的胸部移植。
