Ganapathi Asvin M, Heh Victor, Rosenheck Justin P, Keller Brian C, Mokadam Nahush A, Lampert Brent C, Whitson Bryan A, Henn Matthew C
Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Biostatistics, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Thorac Cardiovasc Surg. 2023 Dec;166(6):1529-1541.e4. doi: 10.1016/j.jtcvs.2022.05.003. Epub 2022 May 15.
For some individuals, chronic allograft failure is best treated with retransplantation. We sought to determine if time to retransplantation impacts short- and long-term outcomes for heart or lung retransplant recipients with a time to retransplantation more than 1 year.
The United Network for Organ Sharing/Organ Procurement and Transplantation Network STAR file was queried for all adult, first-time heart (June 1, 2006, to September 30, 2020) and lung (May 1, 2005, to September 30, 2020) retransplantations with a time to retransplantation of at least 1 year. Patients were grouped according to the tertile of time to retransplantation (tertile 1: 1-7.7 years, tertile 2: 7.7-14.7 years, tertile 3: 14.7+ years; lung: tertile 1: 1-2.8 years, tertile 2: 2.8-5.6 years, tertile 3: 5.6+ years). The primary outcome was survival after retransplantation. Comparative statistics identified differences in groups, and Kaplan-Meier methods and a Cox proportional hazard model were used for survival analysis.
After selection, 908 heart and 871 lung retransplants were identified. Among heart retransplant recipients, tertile 1 was associated with male sex, smoking history, higher listing status, and increased mechanical support pretransplant. Tertile 3 had the highest rate of concomitant kidney transplant; however, the incidence of morbidity and in-hospital mortality was similar among the groups. Unadjusted and adjusted analyses revealed no survival difference among all groups. Regarding lung retransplant recipients, tertile 1 was associated with increased lung allocation score, pretransplant hospitalization, and mechanical support. Unadjusted and adjusted survival analyses revealed decreased survival in tertile 1.
Time to retransplant does not appear to affect heart recipients with a time to retransplantation of more than 1 year; however, shorter time to retransplantation for prior lung recipients is associated with decreased survival. Potential lung retransplant candidates with a time to retransplantation of less than 2.8 years should be carefully evaluated before retransplantation.
对于一些个体而言，慢性移植失败的最佳治疗方法是再次移植。我们试图确定再次移植时间是否会影响再次移植时间超过1年的心脏或肺移植受者的短期和长期预后。
查询器官共享联合网络/器官获取与移植网络的STAR文件，获取所有成年首次心脏（2006年6月1日至2020年9月30日）和肺（2005年5月1日至2020年9月30日）再次移植且再次移植时间至少为1年的患者。根据再次移植时间的三分位数对患者进行分组（三分位数1：1 - 7.7年，三分位数2：7.7 - 14.7年，三分位数3：14.7年以上；肺：三分位数1：1 - 2.8年，三分位数2：2.8 - 5.6年，三分位数3：5.6年以上）。主要结局是再次移植后的生存率。比较统计学方法确定组间差异，采用Kaplan - Meier方法和Cox比例风险模型进行生存分析。
筛选后，确定了908例心脏再次移植和871例肺再次移植。在心脏再次移植受者中，三分位数1与男性、吸烟史、更高的登记状态以及移植前机械支持增加有关。三分位数3的同期肾移植率最高；然而，各组间的发病率和住院死亡率相似。未调整和调整分析均显示各组间生存率无差异。对于肺再次移植受者而言，三分位数1与肺分配评分增加、移植前住院和机械支持有关。未调整和调整后的生存分析显示三分位数1的生存率降低。
再次移植时间似乎不影响再次移植时间超过1年的心脏受者；然而，既往肺移植受者再次移植时间较短与生存率降低有关。再次移植时间少于2.8年的潜在肺再次移植候选者在再次移植前应仔细评估。
