2018 年供者分配结构调整后适应性变化及患者生存情况分析：UNOS 数据库分析
Characterizing Adaptive Changes and Patient Survival After 2018 Donor Allocation Restructuring: A UNOS Database Analysis.
机构信息
From the Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Division of General Surgery, Department of Surgery, University of Vermont, Burlington, VT.
出版信息
Crit Pathw Cardiol. 2024 Jun 1;23(2):81-88. doi: 10.1097/HPC.0000000000000359. Epub 2024 May 22.
PURPOSE
We sought to characterize adaptive changes to the revised United Network for Organ Sharing donor heart allocation policy and estimate long-term survival trends for heart transplant (HTx) recipients.
METHODS
Patients listed for HTx between October 17, 2013 and September 30, 2021 were identified from the United Network for Organ Sharing database, and stratified into pre- and postpolicy revision groups. Subanalyses were performed to examine trends in device utilization for extracorporeal membranous oxygenation (ECMO), durable left ventricular assist device (LVAD), intra-aortic balloon pump (IABP), microaxial support (Impella), and no mechanical circulatory support (non-MCS). Survival data post-HTx were fitted to parametric distributions and extrapolated to 5 years.
RESULTS
We identified 27,523 HTx waitlist candidates during the study period, most of whom (n = 16,376) were waitlisted in the prepolicy change period. Overall, 19,554 patients underwent HTx during the study period (pre: 12,037 and post: 7517). Listings increased after the policy change for ECMO ( P < 0.01), Impella ( P < 0.01), and IABP ( P < 0.01) patients. Listings for LVAD ( P < 0.01) and non-MCS ( P < 0.01) patients decreased. HTx increased for ECMO ( P < 0.01), Impella ( P < 0.01), and IABP ( P < 0.01) patients after the policy change and decreased for LVAD ( P < 0.01) and non-MCS ( P < 0.01) patients. Waitlist survival increased for the overall ( P < 0.01), ECMO ( P < 0.01), IABP ( P < 0.01), and non-MCS ( P < 0.01) groups. Waitlist survival did not differ for the LVAD ( P = 0.8) and Impella ( P = 0.1) groups. Post-transplant survival decreased for the overall ( P < 0.01), LVAD ( P < 0.01), and non-MCS ( P < 0.01) populations.
CONCLUSIONS
Allocation policy revisions have contributed to greater utilization of ECMO, Impella, and IABP, decreased utilization of LVADs and non-MCS, increased waitlist survival, and decreased post-HTx survival.
目的
我们旨在描述对修订后的美国器官共享网络供体心脏分配政策的适应性变化进行特征描述，并估计心脏移植（HTx）受者的长期生存趋势。
方法
从美国器官共享网络数据库中确定了 2013 年 10 月 17 日至 2021 年 9 月 30 日期间接受 HTx 的患者，并将其分为政策修订前和修订后组。进行了亚组分析，以检查体外膜肺氧合（ECMO）、耐用左心室辅助装置（LVAD）、主动脉内球囊泵（IABP）、微轴支撑（Impella）和无机械循环支持（非-MCS）设备利用趋势。HTx 后生存数据拟合到参数分布，并外推至 5 年。
结果
在研究期间，我们确定了 27523 名 HTx 候补名单候选人，其中大多数（n=16376）在政策变更前被列入候补名单。总体而言，在研究期间有 19554 名患者接受了 HTx（前：12037 名，后：7517 名）。政策变更后，ECMO（P<0.01）、Impella（P<0.01）和 IABP（P<0.01）患者的名单增加。LVAD（P<0.01）和非-MCS（P<0.01）患者的名单减少。ECMO（P<0.01）、Impella（P<0.01）和 IABP（P<0.01）患者的 HTx 增加，LVAD（P<0.01）和非-MCS（P<0.01）患者的 HTx 减少。总体而言（P<0.01）、ECMO（P<0.01）、IABP（P<0.01）和非-MCS（P<0.01）组的候补名单生存时间增加。LVAD（P=0.8）和 Impella（P=0.1）组的候补名单生存时间无差异。整体（P<0.01）、LVAD（P<0.01）和非-MCS（P<0.01）人群的移植后生存时间下降。
结论
分配政策修订有助于 ECMO、Impella 和 IABP 的更多利用，LVAD 和非-MCS 的利用减少，候补名单生存时间增加，HTx 后生存时间减少。
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