From the Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky.
Department of Cardiovascular Surgery, Loma Linda University Hospital, Loma Linda, California.
ASAIO J. 2024 Feb 1;70(2):124-130. doi: 10.1097/MAT.0000000000002070. Epub 2023 Oct 20.
Clinical predictors of posttransplant graft loss since the United Network for Organ Sharing (UNOS) heart allocation system change have not been well characterized. Single organ adult heart transplants from the UNOS database were identified (n = 10,252) and divided into a test cohort (n = 6,869, 67%) and validation cohort (n = 3,383, 33%). A Cox regression analysis was performed on the test cohort to identify recipient and donor risk factors for posttransplant graft loss. Based on the risk factors, a score (max 16) was developed to classify patients in the validation cohort into risk groups of low (≤1), mid (2-3), high (≥4) risk. Recipient factors of advanced age, Black race, recipient blood group O, diabetes, etiology of heart failure, renal dysfunction, elevated bilirubin, redo-transplantation, elevated pulmonary artery pressure, transplant with a durable ventricular assist device, or transplant on extracorporeal membrane oxygenation (ECMO) or ventilator were associated with more posttransplant graft loss. Donor factors of ischemic time and donor age were also associated with outcomes. One year graft survival for the low-, mid-, high-risk groups was 94%, 91%, and 85%, respectively. In conclusion, easily obtainable clinical characteristics at time of heart transplant can predict posttransplant outcomes in the current era.
自美国器官共享联合网络（UNOS）心脏分配系统改变以来，移植后移植物丢失的临床预测因素尚未得到很好的描述。从 UNOS 数据库中确定了单器官成人心脏移植（n = 10252），并将其分为测试队列（n = 6869，67%）和验证队列（n = 3383，33%）。在测试队列中进行了 Cox 回归分析，以确定移植后移植物丢失的受体和供体危险因素。根据危险因素，开发了一个评分（最高 16 分），以将验证队列中的患者分为低危（≤1）、中危（2-3）和高危（≥4）风险组。受体年龄较大、黑人、受体血型 O、糖尿病、心力衰竭病因、肾功能障碍、胆红素升高、再次移植、肺动脉压升高、移植带持久心室辅助装置、或在体外膜肺氧合（ECMO）或呼吸机上进行移植与移植后移植物丢失增加相关。供体因素如缺血时间和供体年龄也与结果相关。低、中、高危组的 1 年移植物存活率分别为 94%、91%和 85%。总之，在心脏移植时容易获得的临床特征可以预测当前时代移植后的结果。
