Martinino Alessandro, Ladowski Joseph Matthew, Schilirò Davide, Hartwig Matthew G, Moris Dimitrios, Barbas Andrew S
Department of Surgery, Duke University Medical Center, Durham, NC.
Transplant Direct. 2024 Sep 17;10(10):e1694. doi: 10.1097/TXD.0000000000001694. eCollection 2024 Oct.
The concept of TO is expanding across various surgical disciplines to establish a standardized, comprehensive quality benchmark. Traditional metrics such as 1-y patient and graft survival have been key for evaluating transplant program performance but are now deemed inadequate because of significant field advancements. This systematic review aims to provide a comprehensive understanding of the applicability and validity of textbook outcome (TO) in the setting of solid organ transplantation.
A structured search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, Embase, and Scopus databases on March 10, 2024.
Fourteen articles were identified for inclusion in this review. Of these, 2 studies addressed TO in heart transplantation, 3 in lung transplantation, 2 in kidney transplantation, and 7 in liver transplantation. A subgroup analysis was conducted to categorize the different definitions of TOs and identify the most common reasons for TO failure.
Our systematic review highlights the ongoing efforts in the field of solid organ transplantation to define TO and emphasizes the importance of developing a universally recognized set of TO criteria for each type of transplant. TO provides a valuable framework for transplant centers to benchmark their performance against similar institutions on a risk-adjusted basis and to pinpoint specific areas for enhancing patient outcomes. Even the most successful programs may discover aspects within the composite outcome with scope for improvement.
手术结局（TO）的概念正在各个外科领域不断扩展，以建立标准化、全面的质量基准。传统指标如1年患者生存率和移植物生存率一直是评估移植项目表现的关键指标，但由于该领域的重大进展，现在被认为不够充分。本系统评价旨在全面了解手术结局（TO）在实体器官移植中的适用性和有效性。
2024年3月10日，按照系统评价和Meta分析的首选报告项目指南，在PubMed、Embase和Scopus数据库中进行了结构化检索。
确定了14篇文章纳入本综述。其中，2项研究涉及心脏移植中的手术结局，3项涉及肺移植，2项涉及肾移植，7项涉及肝移植。进行了亚组分析，以对手术结局的不同定义进行分类，并确定手术结局失败的最常见原因。
我们的系统评价突出了实体器官移植领域在定义手术结局方面所做的持续努力，并强调了为每种移植类型制定一套普遍认可的手术结局标准的重要性。手术结局为移植中心提供了一个有价值的框架，使其能够在风险调整的基础上与类似机构比较其表现，并确定可改善患者结局的具体领域。即使是最成功的项目，也可能在综合结局中发现有改进空间的方面。
