Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2021 Apr;36(4):1270-1276. doi: 10.1111/jocs.15359. Epub 2021 Jan 23.
This study explored trends in utilization of marginal donors for orthotopic heart transplantation (OHT) in the United States.
Using the United Network for Organ Sharing database, adults (≥18 years) undergoing OHT between 2009 and 2019 were identified. Marginal donors were defined as having ≥2 of the following: age ≥50 years, ejection fraction less than 50%, ischemic time greater than 240 min, donor-to-recipient body mass index ratio less than 0.8, or donor inotrope use. Kaplan-Meier analysis was utilized to model survival with multivariable Cox regression analysis used for risk-adjustment.
A total of 23,580 recipients underwent OHT with 4896 (20.76%) receiving organs from marginal donors. The use of marginal donors decreased from 25.6% in 2009 to 16.0% in 2017 but accounted for 24.7% of OHTs in 2019. This recent increase in marginal donor use was largely attributable to increased use of donors with ischemic time greater than 240 min, whereas other marginal donor criteria remained stable. Among 140 centers, median marginal donor use was 20.07% (interquartile range, 14.17%-26.51%). An increasing proportion of marginal donors was not associated with increased center-level OHT volume (R < 0.001, p = .833). Marginal donor use was associated with reduced 1- (88.75% vs. 91.87%) and 5-year survival (76.73% vs. 80.08%, p < .001). Following adjustment, marginal donor use remained a significant predictor of post-OHT mortality (hazard ratio, 1.17; p < .001).
Marginal donors account for approximately 20% of OHTs performed in the United States. Despite a reduction in utilization over the past decade, the 2018 allocation change has resulted in a significant increase in use, largely attributable to longer ischemic times.
本研究旨在探讨美国边缘供体用于原位心脏移植（OHT）的利用趋势。
使用美国器官共享网络（United Network for Organ Sharing，UNOS）数据库，确定 2009 年至 2019 年间接受 OHT 的成年人（≥18 岁）。边缘供体的定义为具有以下≥2 种情况：年龄≥50 岁、射血分数<50%、缺血时间>240min、供受者体重指数比值<0.8 或供体使用正性肌力药物。采用 Kaplan-Meier 分析模型进行生存分析，多变量 Cox 回归分析用于风险调整。
共有 23580 例患者接受 OHT，其中 4896 例（20.76%）接受边缘供体器官。边缘供体的使用率从 2009 年的 25.6%下降到 2017 年的 16.0%，但在 2019 年占 OHT 的 24.7%。最近边缘供体使用率的增加主要归因于缺血时间>240min 的供体使用率增加，而其他边缘供体标准保持稳定。在 140 家中心中，边缘供体使用率中位数为 20.07%（四分位距，14.17%-26.51%）。边缘供体使用比例的增加与中心 OHT 量的增加无关（R <0.001，p =0.833）。边缘供体的使用与 1 年（88.75% vs. 91.87%）和 5 年生存率（76.73% vs. 80.08%）降低相关（p <0.001）。调整后，边缘供体的使用仍然是 OHT 后死亡率的显著预测因素（风险比，1.17；p <0.001）。
边缘供体约占美国 OHT 的 20%。尽管在过去十年中使用率有所下降，但 2018 年的分配变化导致使用率显著增加，主要归因于缺血时间延长。
