2019年冠状病毒病大流行对美国药物过量的影响及其对心脏移植量和生存率的影响。
Impact of the coronavirus disease 2019 pandemic on drug overdoses in the United States and the effect on cardiac transplant volume and survival.
作者信息
Phillips Katherine G, James Les, Rabadi Marie, Grossi Eugene A, Smith Deane, Galloway Aubrey C, Moazami Nader
机构信息
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York.
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York.
出版信息
J Heart Lung Transplant. 2024 Mar;43(3):471-484. doi: 10.1016/j.healun.2023.10.015. Epub 2023 Oct 27.
BACKGROUND
Drug overdose (DO) deaths rose to unprecedented levels during the coronavirus disease 2019 (COVID-19) pandemic. This study examines the impact of COVID-19 on the availability of cardiac allografts from DO donors and the implications of DO donor use on recipient survival.
METHODS
Heart transplants reported to the United Network for Organ Sharing from January 2017 to November 2019 ("pre-COVID") and from March 2020 to June 2021 ("COVID pandemic") were analyzed with respect to DO donor status. Outcomes were analyzed using Kaplan-Meier survival and Cox regression to identify predictors of survival. Characteristics of discarded cardiac allografts were also compared by DO donor status.
RESULTS
During the COVID-19 pandemic, 27.2% of cardiac allografts were from DO donors vs 20.5% pre-COVID, a 32.7% increase (p < 0.001). During the pandemic, DO donors were younger (84.7% vs 76.3% <40 years, p < 0.001), had higher cigarette use (16.1% vs 10.8%, p < 0.001), higher cocaine use (47.4% vs 19.7%, p < 0.001), and higher incidence of hepatitis C antibodies (26.8% vs 6.1%, p < 0.001) and RNA positivity (16.2% vs 4.2%, p < 0.001). While DO donors were less likely to require inotropic support (30.8% vs 35.4%, p = 0.008), they were more likely to have received cardiopulmonary resuscitation (95.3% vs 43.2%, p < 0.001). Recipient survival was equivalent using Kaplan-Meier analysis (log-rank, p = 0.33) and survival probability at 36 months was 85.6% (n at risk = 398) for DO donors vs 83.5% (n at risk = 1,633) for all other donors. Cox regression demonstrated that DO donor status did not predict mortality (hazard ratio 1.05; 95% confidence interval 0.90-1.23, p = 0.53).
CONCLUSIONS
During the COVID-19 pandemic, there was a 32.7% increase in heart transplants utilizing DO donor hearts, and DO became the most common mechanism of death for donors. The use of DO donor hearts did not have an impact on short-term recipient survival.
背景
在2019冠状病毒病（COVID-19）大流行期间，药物过量（DO）导致的死亡人数升至前所未有的水平。本研究探讨了COVID-19对DO供体心脏移植可用性的影响，以及使用DO供体对受者生存的影响。
方法
分析了2017年1月至2019年11月（“COVID-19之前”）和2020年3月至2021年6月（“COVID-19大流行期间”）向器官共享联合网络报告的心脏移植中DO供体的情况。使用Kaplan-Meier生存分析和Cox回归分析结果，以确定生存的预测因素。还比较了废弃心脏移植的特征与DO供体情况。
结果
在COVID-19大流行期间，27.2%的心脏移植来自DO供体，而COVID-19之前为20.5%，增加了32.7%（p<0.001）。在大流行期间，DO供体更年轻（<40岁者占84.7% vs 76.3%，p<0.001），吸烟率更高（16.1% vs 10.8%，p<0.001），可卡因使用率更高（47.4% vs 19.7%，p<0.001），丙型肝炎抗体发生率更高（26.8% vs 6.1%，p<0.001）以及RNA阳性率更高（16.2% vs 4.2%，p<0.001）。虽然DO供体需要血管活性药物支持的可能性较小（30.8% vs 35.4%，p = 0.008），但他们接受心肺复苏的可能性更大（95.3% vs 43.2%，p<0.001）。使用Kaplan-Meier分析，受者生存率相当（对数秩检验，p = 0.33），DO供体受者在36个月时的生存概率为85.6%（风险例数=398），而所有其他供体受者为83.5%（风险例数=1633）。Cox回归分析表明，DO供体情况不能预测死亡率（风险比1.05；95%置信区间0.90 - 1.23，p = 0.53）。
结论
在COVID-19大流行期间，使用DO供体心脏进行的心脏移植增加了32.7% [1] ，DO成为供体最常见的死亡原因。使用DO供体心脏对受者短期生存没有影响。
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