Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN.
Division of Nephrology, Department of Medicine, University of Minnesota, Minneapolis, MN.
Transplantation. 2023 Jul 1;107(7):1605-1614. doi: 10.1097/TP.0000000000004518. Epub 2023 Jun 20.
The use of temporary mechanical circulatory support (tMCS) devices (intra-aortic balloon pump; Impella 2.5, CP, 5.0; venoarterial extracorporeal membrane oxygenation) increased significantly across the United States for heart transplant candidates after the allocation policy change. Whether this practice change also affected simultaneous heart-kidney (SHK) candidates and recipient survival is understudied.
We used the Scientific Registry of Transplant Recipients database to identify adult SHK recipients between January 2010 and March 2022. The population was stratified into pre- and post-heart allocation change cohorts. Kaplan-Meier curves were generated to compare 1-y survival rates. A Cox proportional hazards model was used to investigate the effect of allocation period on patient survival. Recipient outcomes bridged with eligible tMCS devices were compared in the post-heart allocation era. In a separate analysis, SHK waitlist mortality was evaluated between the allocation eras.
A total of 1548 SHK recipients were identified, and 1102 were included in the final cohort (534 pre-allocation and 568 post-allocation change). tMCS utilization increased from 17.9% to 51.6% after the allocation change, with venoarterial extracorporeal membrane oxygenation use rising most significantly. However, 1-y post-SHK survival remained unchanged in the full cohort (log-rank P = 0.154) and those supported with any of the eligible tMCS devices. In a separate analysis (using a larger cohort of all SHK listings), SHK waitlist mortality at 1 y was significantly lower in the current allocation era ( P = 0.002).
Despite the remarkable increase in tMCS use in SHK candidates after the heart allocation change, 1 y posttransplant survival remained unchanged. Further studies with larger cohorts and longer follow-ups are needed to confirm these findings.
在美国，心脏分配政策改变后，用于心脏移植候选者的临时机械循环支持（tMCS）设备（主动脉内球囊泵；Impella 2.5、CP、5.0；静脉动脉体外膜肺氧合）的使用显著增加。这种实践的改变是否也影响了同期心脏-肾脏（SHK）候选者和受者的生存，这一点研究得还不够。
我们使用移植受者科学登记处数据库，确定 2010 年 1 月至 2022 年 3 月期间的成年 SHK 受者。人群分为心脏分配政策改变前和改变后队列。生成 Kaplan-Meier 曲线比较 1 年生存率。使用 Cox 比例风险模型调查分配期对患者生存的影响。在心脏分配政策改变后的时期，比较符合条件的 tMCS 设备桥接的受者结局。在单独的分析中，评估了分配期之间的 SHK 候补者死亡率。
共确定了 1548 例 SHK 受者，其中 1102 例纳入最终队列（534 例分配前和 568 例分配后）。分配政策改变后，tMCS 的使用率从 17.9%增加到 51.6%，其中静脉动脉体外膜肺氧合的使用率增长最为显著。然而，在全队列（log-rank P = 0.154）和任何符合条件的 tMCS 设备支持的受者中，SHK 后 1 年的生存率保持不变。在单独的分析（使用所有 SHK 列表的更大队列）中，在当前分配期，SHK 候补者的 1 年死亡率显著降低（P = 0.002）。
尽管心脏分配政策改变后 SHK 候选者中 tMCS 的使用显著增加，但移植后 1 年的生存率保持不变。需要进一步进行队列更大、随访时间更长的研究，以证实这些发现。
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