Sabatino Marlena E, Williams Matthew L, Okwuosa Ike S, Akhabue Ehimare, Kim Jung Hyun, Russo Mark J, Setoguchi Soko
Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Department of Surgery, Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2022 May;113(5):1436-1444. doi: 10.1016/j.athoracsur.2021.08.023. Epub 2021 Sep 21.
Heart failure is an epidemic in the United States, and transplantation remains the most definitive therapy. We describe multidecade trends in posttransplant graft survival, adjusted for concurrent changes in the population, over the 30 years antecedent to the most recent heart allocation policy change.
Scientific Registry of Transplant Recipients data were used to identify all primary adult heart recipients from 1989 to 2017. We described temporal changes in population characteristics (recipient and donor demographics and comorbidities, pretransplant interventions, clinical transplant measures, and providers). The primary outcome was graft survival, defined as freedom from all-cause death and graft failure, within 6 months posttransplant. Modified Poisson logistic regression estimated relative changes in risk of outcomes compared with 1989, with and without adjustment for changing population characteristics. We identified risk factors, quantified by associated risk ratios.
Among 56,488 primary adult heart recipients, we observed 5529 (9.8%) all-cause deaths and 1933 (3.4%) graft failure events within 6 months posttransplant. Prevalence of known recipient risk factors increased over time. Unadjusted modeling demonstrated a significant 30-year improvement in graft survival, averaging 2.6% per year (95% confidence interval, 2.4-2.9; P for trend < .001). After adjusting for population changes the 30-year trend remained significant and graft survival improved on average 3.0% per year (95% confidence interval, 2.6-3.3). Regression modeling identified multiple predictors of graft survival. Modeling 2 additional outcomes of 6-month mortality and 6-month graft failure produced similar results.
Short-term graft survival after heart transplantation has improved significantly leading up to the 2018 heart allocation policy change, despite concurrent increase in prevalence of higher risk population characteristics.
心力衰竭在美国呈流行态势，心脏移植仍是最有效的治疗方法。我们描述了在最近一次心脏分配政策变更之前的30年里，经人群并发变化调整后的移植后移植物存活的数十年趋势。
使用移植受者科学登记处的数据来识别1989年至2017年所有成年心脏初次移植受者。我们描述了人群特征（受者和供者人口统计学及合并症、移植前干预措施、临床移植指标和医疗服务提供者）随时间的变化。主要结局是移植物存活，定义为移植后6个月内无全因死亡和移植物失败。修正泊松逻辑回归估计了与1989年相比结局风险的相对变化，同时调整和未调整人群特征。我们确定了危险因素，并通过相关风险比进行量化。
在56488例成年心脏初次移植受者中，我们观察到移植后6个月内有5529例（9.8%）全因死亡和1933例（3.4%）移植物失败事件。已知受者危险因素的患病率随时间增加。未调整模型显示移植物存活有显著的30年改善，平均每年改善2.6%（95%置信区间，2.4 - 2.9；趋势P <.001）。在调整人群变化后，30年趋势仍然显著，移植物存活平均每年改善3.0%（95%置信区间，2.6 - 3.3）。回归模型确定了移植物存活的多个预测因素。对6个月死亡率和6个月移植物失败的另外两个结局进行建模产生了类似结果。
在2018年心脏分配政策变更之前，尽管高风险人群特征的患病率同时增加，但心脏移植后的短期移植物存活有显著改善。
