在联合器官共享网络分配变更后，左心室辅助装置患者的严重原发性移植物功能障碍增加。
Increased severe primary graft dysfunction in left ventricular assist device patients following united network for organ sharing allocation changes.
机构信息
Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
出版信息
Clin Transplant. 2023 Jan;37(1):e14833. doi: 10.1111/ctr.14833. Epub 2022 Nov 25.
INTRODUCTION
In 2018, the United Network for Organ Sharing (UNOS) implemented a new heart allocation system which prioritized patients on temporary support devices and left-ventricular assist device (LVAD) patients with complications. These changes have the potential to impact outcomes for patients bridged to transplant with an LVAD.
METHODS
We performed a retrospective study of 168 adult heart transplant recipients at our center between 2016 and 2020 evaluating post-transplant outcomes before and after UNOS allocation changes. Donor and recipient data were retrieved from chart review and national databases. The primary outcome of this study was severe primary graft dysfunction (PGD) with secondary outcomes of 30-day readmission, 30-day mortality, and 1-year mortality.
RESULTS
Incidence of severe PGD was similar in the overall cohort before and after the changes (10% vs. 15%, respectively, p = .3) and increased in the LVAD-bridged cohort (12% vs. 40%, respectively, p < .01). Secondary outcomes of readmission and survival were similar between all groups. Blood transfusion was predictive of severe PGD in multivariable modeling (OR 1.3 [1.11-1.59], p < .01).
简介
2018 年，美国器官共享联合网络（UNOS）实施了一项新的心脏分配系统，该系统优先考虑临时支持设备上的患者和有并发症的左心室辅助装置（LVAD）患者。这些变化有可能影响使用 LVAD 桥接移植的患者的结局。
方法
我们对本中心 2016 年至 2020 年间的 168 例成年心脏移植受者进行了回顾性研究，评估了 UNOS 分配变更前后的移植后结局。从图表审查和国家数据库中检索供体和受体数据。本研究的主要结果是严重原发性移植物功能障碍（PGD），次要结果是 30 天再入院、30 天死亡率和 1 年死亡率。
结果
在整个队列中，严重 PGD 的发生率在变更前后相似（分别为 10%和 15%，p=0.3），而在 LVAD 桥接队列中增加（分别为 12%和 40%，p<0.01）。所有组之间的再入院和生存的次要结局相似。输血在多变量模型中是严重 PGD 的预测因素（OR 1.3 [1.11-1.59]，p<0.01）。
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