Ashraf Syed Faaz, Hess Nicholas, Seese Laura, Kavarana Minoo N, Tedford Ryan J, Rajab Taufiek K, Kilic Arman
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
J Heart Lung Transplant. 2022 Mar;41(3):373-381. doi: 10.1016/j.healun.2021.11.006. Epub 2021 Nov 14.
The US adult heart allocation policy was changed on October 18, 2018. This study aims to evaluate its impact on orthotopic heart transplantation (OHT) for adults with congenital heart disease (ACHD).
The United Network for Organ Sharing database was used to perform 2 comparisons: waitlist outcomes among listed ACHD candidates, and post-transplant outcomes in those transplanted. Waitlisted candidates were stratified by date of waitlisting: Period 1: 2010 to 2013; Period 2: 2014 to October 17, 2018 and Period 3: October 18, 2018 to March 20, 2020. Transplanted ACHD patients were similarly stratified but by date of transplantation. Competing risk regression for waitlist outcomes was performed. Post-transplant survival was analyzed using the Kaplan-Meier method and multivariable Cox regression.
Nine hundred and seventy-six patients with ACHD were waitlisted for OHT in our study: 343(35.1%), 466(47.8%), and 167(17.1%) in periods 1, 2, and 3. Post-policy change, 1-year cumulative incidence of waitlist mortality or deterioration decreased (p = 0.02). Six hundred and forty-eight patients were transplanted: 221(34.1%), 329(50.8%) and 98(15.1%) respectively. In those transplanted, post-policy median waitlist time (174, 161 and 38 days, p < 0.001) decreased and the use of intra-aortic balloon pumps increased (1.4%, 4.9% and 19.4%, p < 0.001). Compared to periods 1 and 2, risk-adjusted post-transplant 1-year mortality was similar to period 3 (HR 1.10, 95% CI 0.52-2.32; p = 0.81) (HR 1.19, 95% CI 0.58-2.46, p = 0.63).
The recent US allocation policy change may have resulted in reduced waitlist times and 1-year waitlist mortality for OHTs in ACHD patients. Early post-transplant outcomes appear comparable post-policy change.
2018年10月18日，美国成人心脏分配政策发生了变化。本研究旨在评估其对患有先天性心脏病（ACHD）的成人原位心脏移植（OHT）的影响。
使用器官共享联合网络数据库进行两项比较：登记的ACHD候选者的等待名单结果，以及已移植者的移植后结果。将等待名单上的候选者按登记日期分层：第1期：2010年至2013年；第2期：2014年至2018年10月17日；第3期：2018年10月18日至2020年3月20日。已移植的ACHD患者按移植日期进行类似分层。对等待名单结果进行竞争风险回归分析。使用Kaplan-Meier方法和多变量Cox回归分析移植后的生存率。
在我们的研究中，976例ACHD患者被列入OHT等待名单：第1期、第2期和第3期分别为343例（35.1%）、466例（47.8%）和167例（17.1%）。政策改变后，等待名单上死亡或病情恶化的1年累积发生率下降（p = 0.02）。648例患者接受了移植：分别为221例（34.1%）、329例（50.8%）和98例（15.1%）。在已移植者中，政策改变后等待名单的中位时间（174天、161天和38天，p < 0.001）缩短，主动脉内球囊泵的使用增加（1.4%、4.9%和19.4%，p < 0.001）。与第1期和第2期相比，风险调整后的移植后1年死亡率与第3期相似（风险比1.10，95%置信区间0.52 - 2.32；p = 0.81）（风险比1.19，95%置信区间0.58 - 2.46，p = 0.63）。
美国最近的分配政策变化可能导致ACHD患者OHT的等待时间和等待名单上的1年死亡率降低。政策改变后早期移植后结果似乎相当。
