Echieh Chidiebere Peter, Hamidi Mohammad, Rogers Michael P, Acharya Deepak, Kazui Toshinobu, Hooker Robert L
Department of Surgery, University of Calabar, Calabar, Nigeria.
Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, Banner Tucson, Tucson, AZ, United States.
Int J Cardiol Heart Vasc. 2024 Aug 13;54:101486. doi: 10.1016/j.ijcha.2024.101486. eCollection 2024 Oct.
The United Network for Organ Sharing (UNOS) heart transplant allocation policy was changed in 2018. This study examines the impact of the change in UNOS heart transplant allocation policy on the use of temporary mechanical circulatory support (MCS) devices and post-transplant survival. The analysis included a total of 26,481 patients listed and transplanted between January 2013 and June 2022. The results showed a decrease in waiting time for transplant after the policy change, indicating a successful reduction in waitlist time for high-priority status patients. However, the length of hospital stays from transplant to discharge increased following the policy change. The study also found an increase in the frequency of ECMO and IABP use both at the time of listing and at the time of transplant following the policy change. Cumulative patient and graft survival at 1000 days decreased following the policy change (86.1 per cent versus 83.7 per cent at 1000 days, p = 0.002). However, the survival curves showed similar survival trends in the first 2 years, with late divergence in survival occurring after 2 years. In conclusion the latest UNOS heart transplant allocation policy change led to a decrease in waiting times and an increase in the use of temporary MCS devices. There was a decrease in cummulative survival at 1000 days following the policy change.
器官共享联合网络（UNOS）的心脏移植分配政策于2018年发生了变化。本研究考察了UNOS心脏移植分配政策的变化对临时机械循环支持（MCS）设备使用情况及移植后生存率的影响。该分析纳入了2013年1月至2022年6月期间登记并接受移植的共计26481例患者。结果显示，政策变化后移植等待时间缩短，这表明高优先级状态患者的等待名单时间成功缩短。然而，政策变化后，从移植到出院的住院时间延长。该研究还发现，政策变化后，在登记时和移植时使用体外膜肺氧合（ECMO）和主动脉内球囊反搏（IABP）的频率均有所增加。政策变化后，1000天时的累积患者和移植物生存率下降（1000天时为86.1%对83.7%，p = 0.002）。然而，生存曲线在前2年显示出相似的生存趋势，2年后生存出现后期差异。总之，最新的UNOS心脏移植分配政策变化导致等待时间缩短以及临时MCS设备使用增加。政策变化后，1000天时的累积生存率下降。
