Baylor College of Medicine, Department of Medicine, Houston, Texas, USA.
Baylor College of Medicine, Department of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA.
JACC Heart Fail. 2023 May;11(5):491-503. doi: 10.1016/j.jchf.2023.01.009. Epub 2023 Mar 1.
In 2018, the United Network for Organ Sharing implemented a 6-tier allocation policy to replace the prior 3-tier system. Given increasing listings of critically ill candidates for heart transplantation and lengthening waitlist times, the new policy aimed to better stratify candidates by waitlist mortality, shorten waiting times for high priority candidates, add objective criteria for common cardiac conditions, and further broaden sharing of donor hearts. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy, including changes in listing practices, waitlist time and mortality, transplant donor characteristics, post-transplantation outcomes, and mechanical circulatory support use. This review aims to highlight emerging trends in United States heart transplantation practice and outcomes following the implementation of the 2018 United Network for Organ Sharing heart allocation policy and to address areas for future modification.
2018 年，美国器官共享联合网络实施了六级分配政策，以取代之前的三级系统。鉴于需要进行心脏移植的病危候选人名单不断增加，以及候补名单时间延长，新政策旨在通过候补名单死亡率更好地对候选人进行分层，缩短高优先级候选人的等待时间，为常见心脏状况增加客观标准，并进一步扩大供体心脏的共享。新政策实施后，心脏移植实践和患者结果发生了重大变化，包括列入名单的做法、候补名单时间和死亡率、移植供体特征、移植后结果和机械循环支持的使用。本综述旨在强调 2018 年美国器官共享联合网络心脏分配政策实施后美国心脏移植实践和结果中出现的新趋势，并讨论未来需要改进的领域。
