Shudo Yasuhiro, Leipzig Matthew, He Hao, Ingle Shreya Mukund, Bhatt Rishab Harish, Shin Hye-Sook, Woo Y Joseph
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Natural Sciences, Rice University, Houston, Texas, USA.
JACC Asia. 2022 Jul 5;2(4):504-512. doi: 10.1016/j.jacasi.2022.03.012. eCollection 2022 Aug.
Heart-lung transplantation (HLTx) is a definitive surgical procedure for end-stage cardiopulmonary failure. Studies to understand the relationship between ethnicity and race and outcomes after HLTx are needed to uphold equitable HLTx access to the increasingly diverse U.S. population facing advanced cardiopulmonary failure.
This study sought to examine the outcomes of HLTx recipients of Asian origin, with emphasis on the ethnic and racial disparities in the outcomes.
We analyzed data from the United Network for Organ Sharing (UNOS) for patients of ≥18 years of age who underwent HLTx between 1987 and 2021. Propensity-score matching was performed between Asian and non-Hispanic Whites (NHWs), with a 1:3 matching ratio based on the propensity score of each patient estimated by multivariable logistic regression.
We identified 42 Asian and Asian American heart-lung transplant recipients and 834 NHW recipients. In the pre-matched cohort, the median survival was 1,459 days (IQR: 1,080-2,692 days) in Asian recipients after transplantation, whereas it was 1,521 days (IQR: 1,262-1,841 days) in White recipients. Of the 876 recipients, 156 transplants were successfully matched (Asian, n = 36; NHW, n = 108). Among the post-transplantation outcomes, there were no significant differences in morbidity and mortality between Asian and NHW cohorts.
This large-scale analysis in Asian patients will have important implications in Asian countries that have relatively fewer HLTx surgeries. An outcome equivalent to NHW in Asian patients, as demonstrated in our study, could be the driving force for further expansion of HLTx surgeries in Asian countries.
心肺移植（HLTx）是终末期心肺衰竭的确定性外科手术。为了确保面临晚期心肺衰竭的日益多样化的美国人群能够公平地获得HLTx，需要开展研究以了解种族与HLTx术后结局之间的关系。
本研究旨在探讨亚洲裔HLTx受者的结局，重点关注结局中的种族差异。
我们分析了器官共享联合网络（UNOS）中1987年至2021年间接受HLTx的≥18岁患者的数据。在亚洲人和非西班牙裔白人（NHW）之间进行倾向评分匹配，根据多变量逻辑回归估计的每位患者的倾向评分，匹配比例为1:3。
我们确定了42名亚洲和亚裔美国心肺移植受者以及834名NHW受者。在未匹配队列中，亚洲受者移植后的中位生存期为1459天（IQR：1080 - 2692天），而白人受者为1521天（IQR：1262 - 1841天）。在876名受者中，156例移植成功匹配（亚洲人，n = 36；NHW，n = 108）。在移植后结局方面，亚洲和NHW队列之间的发病率和死亡率没有显著差异。
这项针对亚洲患者的大规模分析将对HLTx手术相对较少的亚洲国家具有重要意义。正如我们的研究所表明的，亚洲患者的结局与NHW相当，这可能是亚洲国家进一步扩大HLTx手术的驱动力。
