Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York.
J Heart Lung Transplant. 2023 Nov;42(11):1497-1500. doi: 10.1016/j.healun.2023.07.012. Epub 2023 Jul 26.
The 2018 heart allocation policy sought to improve risk stratification and reduce waitlist mortality for the sickest patients. This study sought to evaluate changes in wait times for the highest priority patients since policy implementation. All adult single-organ transplant recipients were identified in the United Network for Organ Sharing registry from October 18, 2018, to July 8, 2022, and separated into 4 periods. Outcomes were compared by blood type and UNOS region. Over the study period, 897 of 9,143 patients were listed as status 1 with no significant change in median wait time by blood type or region. More patients were listed as status 2 (4,523/9,143), and each subsequent period postpolicy change was associated with a 4.2-day increase in mean status 2 waitlist time (95% confidence interval 3.0-5.5, p < 0.0001). Wait times were longest for candidates with blood type O and shortest for AB & A. Regional variations continued, however, wait time increased in every region over time.
2018 年心脏分配政策旨在改善风险分层并降低病情最严重患者的候补名单死亡率。本研究旨在评估自政策实施以来，优先级最高患者的候补时间变化。自 2018 年 10 月 18 日至 2022 年 7 月 8 日，从美国器官共享网络登记处确定了所有成年单器官移植受者，并将其分为 4 个时期。通过血型和 UNOS 区域比较结果。在研究期间，9143 名患者中有 897 名列为 1 级，血型或区域对中位候补时间无明显变化。更多的患者被列为 2 级（4523/9143），政策变更后每个后续时期的平均 2 级候补名单时间增加了 4.2 天（95%置信区间 3.0-5.5，p<0.0001）。O 型血患者的候补时间最长，AB 和 A 型血患者的候补时间最短。然而，区域差异仍在继续，随着时间的推移，每个区域的候补时间都在增加。
