Meyer J Sam, Sweitzer Nancy, Aravot Dan, Milano Carmelo A, Barac Yaron D
Division of Cardiovascular and Thoracic Surgery, Rabin Medical Center, Petach-Tikva, Israel.
Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel.
JTCVS Open. 2024 Oct 16;22:306-317. doi: 10.1016/j.xjon.2024.09.028. eCollection 2024 Dec.
The transplantation of hearts from donors who experienced intracranial bleeding (ICB) has been associated with inferior long-term survival in both single-center analyses and, more recently, with the United Network for Ogan Sharing Registry. The purpose of this study was to further explore this relationship through propensity score matching in recipients receiving donor hearts from ICB and non-ICB donors in a large national registry.
We performed a retrospective cohort analysis of the United Network for Organ Sharing Registry Organ Procurement and Transplantation Network between 2006 and 2018 for adult candidates wait-listed for isolated heart transplantation. Recipients were stratified into 2 groups: ICB and non-ICB donors. Propensity score matching was performed to estimate causal effects by using observational data. Kaplan-Meier analysis was used to estimate survival posttransplant. Cox proportional hazards modeling was used to evaluate the independent effect of ICB as a cause of death.
A total of 25,315 candidates met inclusion criteria. ICB heart donors (n = 5529) were older (median age, 42 vs 27 years; < .001), less likely men (54.5% vs 75.2%; < .001), and more often had a history of smoking (20.1% vs 11.7%; < .001), and hypertension (34.2% vs 9.5%; < .001). Before matching there was a significant difference in long-term posttransplant survival; for example, the non-ICB (60.7% [interquartile range, 59.5%-61.9%] vs 56.8% (interquartile range, 54.7%-59.0%]; < .0001). However, when analyzing the propensity-score matched groups for outcomes, no difference was found between the cohorts both in terms of long-term survival as well as in rates of rejection.
In the largest propensity score matching analysis of heart transplants from donors who had experienced ICB, we found similar survival and rejection rates in heart transplant recipients.
在单中心分析以及最近的器官共享联合网络登记处中，接受颅内出血（ICB）供体心脏移植与较差的长期生存率相关。本研究的目的是通过倾向评分匹配，在一个大型国家登记处中进一步探索接受ICB供体和非ICB供体心脏移植的受者之间的这种关系。
我们对2006年至2018年期间器官共享联合网络登记处器官采购与移植网络中等待孤立心脏移植的成年候选者进行了回顾性队列分析。受者被分为两组：ICB供体组和非ICB供体组。通过使用观察数据进行倾向评分匹配来估计因果效应。采用Kaplan-Meier分析来估计移植后的生存率。采用Cox比例风险模型来评估ICB作为死亡原因的独立效应。
共有25315名候选者符合纳入标准。ICB心脏供体（n = 5529）年龄更大（中位年龄，42岁对27岁；P <.001），男性比例更低（54.5%对75.2%；P <.001），且更常吸烟（20.1%对11.7%；P <.001）和患有高血压（34.2%对9.5%；P <.001）。匹配前，移植后的长期生存率存在显著差异；例如，非ICB组为60.7%（四分位间距，59.5% - 61.9%）对ICB组的56.8%（四分位间距，54.7% - 59.0%）；P <.0001）。然而，在分析倾向评分匹配组的结果时，两组在长期生存率以及排斥率方面均未发现差异。
在对经历ICB的供体心脏移植进行的最大规模倾向评分匹配分析中，我们发现心脏移植受者的生存率和排斥率相似。
