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欧洲和北美中心肺移植术后结果的比较。

A comparison of outcomes after lung transplantation between European and North American centers.

机构信息

Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri.

Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri.

出版信息

J Heart Lung Transplant. 2022 Dec;41(12):1729-1735. doi: 10.1016/j.healun.2022.07.014. Epub 2022 Jul 21.

DOI:10.1016/j.healun.2022.07.014
PMID:35970646
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10305841/
Abstract

BACKGROUND

With advancements in basic science and clinical medicine, lung transplantation (LT) has evolved rapidly over the last three decades. However, it is unclear if significant regional variations exist in long-term outcomes after LT.

METHODS

To investigate potential differences, we performed a retrospective, comparative cohort analysis of adult patients undergoing deceased donor single or double LT in North America (NA) or Europe between January 2006 and December 2016. Data up to April 2019 were abstracted from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Registry. We compared overall survival (OS) between North American and European LT centers in a propensity score matched analysis.

RESULTS

In 3,115 well-matched pairs, though 30-day survival was similar between groups (NA 96.2% vs Europe 95.4%, p = 0.116), 5-year survival was significantly higher in European patients (NA 60.1% vs Europe 70.3%, p < 0.001).

CONCLUSIONS

This survival difference persisted in a sensitivity analysis excluding Canadian patients. Prior observations suggest that these disparities are at least partly related to better access to care via universal healthcare models prevalent in Europe. Future studies are warranted to confirm our findings and explore other causal mechanisms. It is likely that potential solutions will require concerted efforts from healthcare providers and policymakers.

摘要

背景

随着基础科学和临床医学的进步，肺移植（LT）在过去三十年中迅速发展。然而，尚不清楚 LT 后长期结果是否存在显著的区域差异。

方法

为了研究潜在的差异，我们对 2006 年 1 月至 2016 年 12 月期间在北美（NA）或欧洲接受已故供体单肺或双肺 LT 的成年患者进行了回顾性、比较队列分析。数据从国际心肺移植协会（ISHLT）胸部器官登记处提取至 2019 年 4 月。我们在倾向评分匹配分析中比较了北美和欧洲 LT 中心之间的总生存率（OS）。

结果

在 3115 对匹配良好的患者中，尽管两组患者的 30 天生存率相似（NA 为 96.2%，欧洲为 95.4%，p=0.116），但欧洲患者的 5 年生存率明显更高（NA 为 60.1%，欧洲为 70.3%，p<0.001）。

结论

在排除加拿大患者的敏感性分析中，这种生存差异仍然存在。先前的观察表明，这些差异至少部分与欧洲普遍存在的通过全民医疗保健模式获得更好的治疗机会有关。需要进一步的研究来证实我们的发现并探讨其他因果机制。很可能需要医疗保健提供者和政策制定者的共同努力来找到潜在的解决方案。