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器官获取组织型复苏设施与急性医疗机构中已故器官捐献者的器官移植结局比较。

Organ Transplantation Outcomes of Deceased Organ Donors in Organ Procurement Organization-Based Recovery Facilities Versus Acute-Care Hospitals.

机构信息

Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.

Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Prog Transplant. 2023 Jun;33(2):110-120. doi: 10.1177/15269248231164176. Epub 2023 Mar 21.

Abstract

INTRODUCTION

Recovery of donated organs at organ procurement organization (OPO)-based recovery facilities has been proposed to improve organ donation outcomes, but few data exist to characterize differences between facilities and acute-care hospitals.

RESEARCH QUESTION

To compare donation outcomes between organ donors that underwent recovery procedures in OPO-based recovery facilities and hospitals.

DESIGN

Retrospective study of Organ Procurement and Transplantation Network data. From a population-based sample of deceased donors after brain death April 2017 to June 2021, donation outcomes were examined in 10 OPO regions with organ recovery facilities. Primary exposure was organ recovery procedure in an OPO-based organ recovery. Primary outcome was the number of organs transplanted per donor. Multivariable regression models were used to adjust for donor characteristics and managing OPO.

RESULTS

Among 5010 cohort donors, 2590 (51.7%) underwent recovery procedures in an OPO-based facility. Donors in facilities differed from those in hospitals, including recovery year, mechanisms of death, and some comorbid diseases. Donors in OPO-based facilities had higher total numbers of organs transplanted per donor (mean 3.5 [SD1.8] vs 3.3 [SD1.8]; adjusted mean difference 0.27, 95% confidence interval 0.18-0.36). Organ recovery at an OPO-based facility was also associated with more lungs, livers, and pancreases transplanted.

CONCLUSION

Organ recovery procedures at OPO-based facilities were associated with more organs transplanted per donor than in hospitals. Increasing access to OPO-based organ recovery facilities may improve rates of organ transplantation from deceased organ donors, although further data are needed on other important donor management quality metrics.

摘要

简介

在器官获取组织(OPO)的回收设施中恢复捐献器官已被提议用于改善器官捐献结果,但几乎没有数据可以描述设施与急症医院之间的差异。

研究问题

比较在 OPO 基础回收设施和医院接受恢复程序的器官捐献者的捐献结果。

设计

对器官采购和移植网络数据的回顾性研究。从 2017 年 4 月至 2021 年 6 月脑死亡后基于人群的已故捐献者样本中,在 10 个拥有器官回收设施的 OPO 地区检查了捐献结果。主要暴露是在 OPO 基础的器官回收中进行器官回收程序。主要结果是每个捐献者移植的器官数量。使用多变量回归模型调整供体特征和管理 OPO。

结果

在 5010 名队列供体中,2590 名(51.7%)在 OPO 基础的设施中接受了恢复程序。设施中的供体与医院中的供体不同,包括恢复年份、死亡机制和一些合并症。在 OPO 基础的设施中,每个供体移植的器官总数更高(平均 3.5 [SD1.8] vs 3.3 [SD1.8];调整后的平均差异 0.27,95%置信区间 0.18-0.36)。在 OPO 基础的设施中进行器官回收也与更多的肺、肝和胰腺移植有关。

结论

与医院相比,在 OPO 基础的设施中进行器官回收程序与每个供体移植的器官数量更多相关。增加对 OPO 基础的器官回收设施的使用可能会提高已故器官捐献者的器官移植率,尽管还需要更多关于其他重要供体管理质量指标的数据。

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