Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Pediatric Cardiothoracic Surgery, Heart Institute, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2021 Apr;36(4):1249-1257. doi: 10.1111/jocs.15356. Epub 2021 Jan 23.
This study evaluated the impact of the heart allocation policy change in 2018 on the characteristics and outcomes of multiorgan transplants involving heart allografts.
Adults undergoing multiorgan heart transplantation from 2010 to 2020 were identified from the United Network for Organ Sharing (UNOS) registry. Transplants were stratified into occurring before versus after the October 2018 heart allocation change. The primary outcome was 1-year survival following transplantation. A Cox proportional hazards model was used to evaluate the risk-adjusted effect of the allocation policy change on outcomes between cohorts.
A total of 1832 patients underwent multiorgan heart transplantation during the study period with 245 (13.37%) undergoing heart-lung transplantation, 244 (13.32%) undergoing heart-liver transplantation, and 1343 (73.31%) undergoing heart-kidney transplantation. There was a higher utilization of temporary MCSDs as well as longer ischemic times for all three types of transplantation following the policy change. Heart-lung and heart-liver recipients had a similar 1-year survival before and after the policy change (each p > .05). Renal failure requiring dialysis (29.5% vs. 39.4%, p = .001) as well as 1-year survival (88% vs. 82%; log-rank p = .01) were worse in the heart-kidney cohort after the organ allocation system modification.
This study demonstrates similar trends in multiorgan transplants as has been observed in isolated heart transplants following the allocation change, including more frequent utilization of temporary mechanical support and longer ischemic times. Although outcomes have remained comparable in the new allocation era with heart-lung and heart-liver transplants, heart-kidney recipients have a worse 1-year survival following the change.
本研究评估了 2018 年心脏分配政策变化对涉及心脏移植物的多器官移植的特征和结果的影响。
从美国器官共享网络（UNOS）登记处确定了 2010 年至 2020 年期间接受多器官心脏移植的成年人。将移植分为在 2018 年 10 月心脏分配变更之前和之后进行的移植。主要结果是移植后 1 年的生存率。使用 Cox 比例风险模型评估分配政策变更对队列之间结果的风险调整影响。
在研究期间，共有 1832 例患者接受了多器官心脏移植，其中 245 例（13.37%）接受了心肺联合移植，244 例（13.32%）接受了心肝联合移植，1343 例（73.31%）接受了心脏-肾脏移植。在政策变更后，所有三种类型的移植都更多地使用了临时机械循环支持，并且缺血时间也更长。心肺和心肝受体在政策变更前后的 1 年生存率相似（均 p > .05）。在器官分配系统修改后，心脏-肾脏移植的患者发生需要透析的肾功能衰竭（29.5%比 39.4%，p = .001）和 1 年生存率（88%比 82%；对数秩检验 p = .01）更差。
本研究表明，在分配变更后，多器官移植也出现了与孤立心脏移植相似的趋势，包括更频繁地使用临时机械支持和更长的缺血时间。尽管在新的分配时代，心肺和心肝移植的结果仍然相似，但心脏-肾脏移植的患者在政策变更后 1 年的生存率更差。
