Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA.
J Card Surg. 2022 Jul;37(7):2042-2050. doi: 10.1111/jocs.16558. Epub 2022 Apr 30.
Unsupervised statistical determination of optimal allograft ischemic time (IT) on heart transplant outcomes among ABO donor heart types.
We identified 36,145 heart transplants (2000-2018) from the United Network for Organ Sharing database. Continuous and categorical variables were analyzed with parametric and nonparametric testing. Determination of IT cutoffs for survival analysis was performed using Contal and O'Quigley univariable method and Vito Muggeo multivariable segmented modeling.
Univariable and multivariable IT threshold determination revealed a cutoff at about 3 h. The hourly increase in survival risk with ≥3 h IT is asymmetrically experienced at the early 90 days (hazard ratio [HR] = 1.29, p < .001) and up to 1-year time point (HR = 1.16, p < .001). Beyond 1 year the risk of prolonged IT is less impactful (HR = 1.04, p = .022). Longer IT was associated with more postoperative complications such as stroke (2.7% vs. 2.3, p = .042), dialysis (11.6% vs. 9.1%, p < .001) and death from primary graft dysfunction (1.8% vs. 1.2%, p < .001). O blood type donor hearts with IT ≥ 3 h has significantly increased hourly mortality risk at 90 days (HR = 1.27, p < .001), 90 days to 1 year (HR = 1.22, p < .001) and >1 year (HR = 1.05, p = .041). For non-O blood types with ≥3 h IT hourly mortality risk was increased at 90 days (HR = 1.33, p < .001), but not at 90 days to 1 year (HR = 1.09, p = .146) nor ≥1 year (HR = 1.08, p = .237).
The donor heart IT threshold for survival determined from unbiased statistical modeling occurs at 3 h. With longer preservation times, transplantation with O donor hearts was associated with worse survival.
在 ABO 供体心脏类型中，通过无监督统计方法确定最佳同种异体移植物缺血时间（IT）对心脏移植结局的影响。
我们从器官共享联合网络数据库中确定了 36145 例心脏移植（2000-2018 年）。采用参数和非参数检验分析连续和分类变量。使用 Contal 和 O'Quigley 单变量法和 Vito Muggeo 多变量分段建模来确定 IT 截断值以进行生存分析。
单变量和多变量 IT 阈值确定显示，约 3 小时处存在截断值。≥3 小时 IT 后，早期 90 天（风险比[HR] = 1.29，p < 0.001）和 1 年时间点（HR = 1.16，p < 0.001）的生存风险呈不对称性增加。1 年以后，长时间 IT 的风险影响较小（HR = 1.04，p = 0.022）。较长的 IT 与更多的术后并发症相关，如中风（2.7% vs. 2.3%，p = 0.042）、透析（11.6% vs. 9.1%，p < 0.001）和原发性移植物功能障碍导致的死亡（1.8% vs. 1.2%，p < 0.001）。O 型血供体心脏 IT≥3 小时时，90 天（HR = 1.27，p < 0.001）、90 天至 1 年（HR = 1.22，p < 0.001）和>1 年（HR = 1.05，p = 0.041）的每小时死亡率风险显著增加。对于非 O 型血供体，≥3 小时 IT 时，90 天的每小时死亡率风险增加（HR = 1.33，p < 0.001），但 90 天至 1 年（HR = 1.09，p = 0.146）和≥1 年（HR = 1.08，p = 0.237）时则不然。
从无偏统计模型确定的供体心脏 IT 生存阈值为 3 小时。随着保存时间的延长，O 型供体心脏移植的存活率更差。
