Merlo Aurelie, Bensimhon Hannah F, Chang Patricia P, Yu Zhentao, Watkins Randall, Li Quefeng, Byku Mirnela
Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Division of Cardiology, Dartmouth University, Hanover, New Hampshire.
JHLT Open. 2024 Feb 15;4:100071. doi: 10.1016/j.jhlto.2024.100071. eCollection 2024 May.
The 2018 United Network for Organ Sharing organ allocation change aimed to distribute donor hearts to the sickest patients on the waitlist. Whether this change differentially affected outcomes in heart-only vs heart-kidney transplant recipients is unknown.
This study used the Scientific Registry of Transplant Recipients to compare outcomes, including survival, of heart-only and heart-kidney transplant recipients from 2015 to 2021, from the old vs new allocation system, including use of mechanical circulatory support (MCS), prior to transplant.
During the study period, 16,696 patients underwent heart transplant alone (9,320 in the old and 7,376 in the new system) and 1,156 patients underwent heart-kidney transplant (529 in the old and 627 in the new system). For both heart and heart-kidney transplant populations, there was a 3- to 5-fold increase in the use of temporary MCS. Heart-only recipients had worse survival when temporary MCS was used in the old allocation system. Heart-only recipients with durable MCS had worse survival both in the old and the new allocation system. There was no difference in survival in heart-kidney recipients in the old vs new allocation system, regardless of MCS use.
The new heart allocation system was associated with increased use of temporary MCS in both heart and heart-kidney recipients. However, this change only differentially affected survival in heart-only recipients with improved survival if on temporary MCS, but worse survival if on durable MCS. Unlike prior studies, heart-kidney recipients did not have different outcomes after the heart allocation change, which may reflect outcomes in more current times.
2018年器官共享联合网络的器官分配变更旨在将供体心脏分配给等待名单上病情最严重的患者。这种变更对单纯心脏移植受者与心脏-肾脏移植受者的结局是否产生不同影响尚不清楚。
本研究利用移植受者科学登记系统，比较了2015年至2021年单纯心脏移植受者与心脏-肾脏移植受者在旧的与新的分配系统下的结局，包括生存率，这些受者在移植前使用了机械循环支持（MCS）。
在研究期间，16,696例患者接受了单纯心脏移植（旧系统中有9,320例，新系统中有7,376例），1,156例患者接受了心脏-肾脏移植（旧系统中有529例，新系统中有627例）。对于心脏移植和心脏-肾脏移植人群，临时MCS的使用增加了3至5倍。在旧的分配系统中使用临时MCS时，单纯心脏移植受者的生存率较差。在旧的和新的分配系统中，使用持久MCS的单纯心脏移植受者的生存率都较差。无论是否使用MCS，旧的与新的分配系统中心脏-肾脏移植受者的生存率均无差异。
新的心脏分配系统与心脏移植和心脏-肾脏移植受者中临时MCS使用的增加有关。然而，这种变更仅对单纯心脏移植受者的生存率产生不同影响，即使用临时MCS时生存率提高，但使用持久MCS时生存率降低。与先前的研究不同，心脏-肾脏移植受者在心脏分配变更后的结局没有差异，这可能反映了当前时期的结局。
