Rekhtman David, Lee Sharon, Iyengar Amit, Song Cindy, Weingarten Noah, Shin Max, Asher Michaela, Jiang Joyce, Cevasco Marisa, Atluri Pavan
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
JTCVS Open. 2025 Mar 10;25:241-252. doi: 10.1016/j.xjon.2025.02.019. eCollection 2025 Jun.
In the new US heart transplant allocation system, eligible patients can receive hearts from donors beyond a 250-mile radius. The safety of extended travel and its impact on ischemic time are poorly understood. This study examines post-transplantation mortality based on distance between donor and transplant centers.
Adult patients listed as status 1 or 2 for isolated heart transplantation between October 18, 2018, and September 30, 2023, who subsequently received an organ were identified in the United Network for Organ Sharing database. Patients were stratified by donor distance (≤250 or >250 miles). Linear and logistic models analyzed the relationships among 1-year survival, distance, and ischemic time. The 1-year mortality was further characterized by Kaplan-Meier analysis.
Of the 5315 patients included in this cohort, 45% received hearts within a 250-mile radius, and 55% received hearts from distances beyond 250 miles. The majority of patients were male and White, and had dilated cardiomyopathy. Assessment of the relationship between distance and ischemic time showed an 18-minute increase for every additional 100 miles of travel. Multivariable logistic regression indicated increased mortality with longer ischemic times, but no difference in survival with increasing distances. Further, on multivariable time-dependent analysis, increasing ischemic time was a predictor of mortality (odds ratio, 1.19 [1.01-1.21]), whereas increased donor distance was not (odds ratio, 0.84 [0.68-1.04]).
Distance between donor and transplant center minimally affected ischemic time and showed no impact on post-transplant 1-year survival. Therefore, ischemic time limitations rather than distance cutoffs may be more appropriate for policies regarding heart procurement.
在新的美国心脏移植分配系统中，符合条件的患者可以接受来自半径250英里以外供体的心脏。人们对长途运输的安全性及其对缺血时间的影响了解甚少。本研究基于供体与移植中心之间的距离，探讨移植后的死亡率。
在器官共享联合网络数据库中，识别出2018年10月18日至2023年9月30日期间被列为孤立性心脏移植1级或2级状态、随后接受器官移植的成年患者。患者按供体距离（≤250英里或>250英里）分层。线性和逻辑模型分析了1年生存率、距离和缺血时间之间的关系。1年死亡率通过Kaplan-Meier分析进一步描述。
在该队列纳入的5315例患者中，45%接受了半径250英里范围内的心脏，55%接受了距离超过250英里的心脏。大多数患者为男性和白人，患有扩张型心肌病。距离与缺血时间关系的评估显示，每增加100英里行程，缺血时间增加18分钟。多变量逻辑回归表明，缺血时间延长会增加死亡率，但生存率不会随距离增加而有差异。此外，在多变量时间依赖性分析中，缺血时间增加是死亡率的预测因素（比值比，1.19 [1.01-1.21]），而供体距离增加则不是（比值比，0.84 [0.68-1.04]）。
供体与移植中心之间的距离对缺血时间影响极小，且对移植后1年生存率无影响。因此，对于心脏获取政策而言，缺血时间限制而非距离界限可能更为合适。
