The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States
The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States
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DOI：
10.7326/m17-2451
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发表时间：
2018-05-15
影响因子：
39.2
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
Durand, Christine M.;Bowring, Mary G.;Segev, Dorry L.
背景资料：药物过量死亡在美国的流行导致了器官捐献者的增加。目的：描述死于药物过量的捐献者并分析移植受者的结局。设计：前瞻性观察性队列研究。设置：移植受者的科学登记，2000年1月1日至2017年9月1日。参与者：138 565名已故捐献者;在297个移植中心的337 934名移植受者中进行测量：主要暴露是供体死亡机制（过量死亡供体[ODD]、创伤死亡供体[TDD]或医疗死亡供体[MDD]）。采用倾向评分加权标准化风险差（sRDs）比较患者和移植物存活率和器官丢弃（器官回收但未移植）。结果：共确定了7313例ODD和19897例ODD移植（10347例肾脏，5707例肝脏，2471例心脏和1372例肺）。2000年，过量死亡献血者占献血者的1.1%，2017年占13.4%。他们更可能是白色（85.1%），年龄21至40岁（66.3%），感染丙型肝炎病毒（HCV）（18.3%），和增加感染风险的供体（IRD）（56.4%）。ODD器官接受者的标准化5年患者生存率与TDD器官接受者（sRDs范围为生存率低3.1%至高3.9%）和MDD器官接受者（sRDs范围为生存率高2.1%至5.2%）相似。ODD和TDD移植物之间的标准化5年移植物存活率相似（肾脏和肺差异极小，肝脏略低[sRD，-3.2%]，心脏略高[sRD，1.9%]）。肾脏丢弃是较高的ODDs比TDDs（sRD，5.2%）或MDDs（sRD，1.5%）; HCV和IRD状态的标准化减弱了这种差异。限制：无法区分阿片类药物和非阿片类药物overdoses.Conclusion：在美国，移植与ODD器官有显着增加，在移植受者的非劣效性结果。考虑到目前的器官短缺，对IRD行为和供体中丙型肝炎的担忧导致过度丢弃，应尽量减少。
Background: The epidemic of drug overdose deaths in the United States has led to an increase in organ donors.Objective: To characterize donors who died of overdose and to analyze outcomes among transplant recipients.Design: Prospective observational cohort study.Setting: Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017.Participants: 138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers.Measurements: The primary exposure was donor mechanism of death (overdose-death donor [ODD], trauma-death donor [TDD], or medical-death donor [MDD]). Patient and graft survival and organ discard (organ recovered but not transplanted) were compared using propensity score-weighted standardized risk differences (sRDs).Results: A total of 7313 ODDs and 19 897 ODD transplants (10 347 kidneys, 5707 livers, 2471 hearts, and 1372 lungs) were identified. Overdose-death donors accounted for 1.1% of donors in 2000 and 13.4% in 2017. They were more likely to be white (85.1%), aged 21 to 40 years (66.3%), infected with hepatitis C virus (HCV) (18.3%), and increased-infectious risk donors (IRDs) (56.4%). Standardized 5-year patient survival was similar for ODD organ recipients compared with TDD organ recipients (sRDs ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival). Standardized 5-year graft survival was similar between ODD and TDD grafts (minimal difference for kidneys and lungs, marginally lower [sRD, -3.2%] for livers, and marginally higher [sRD, 1.9%] for hearts). Kidney discard was higher for ODDs than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for HCV and IRD status attenuated this difference.Limitation: Inability to distinguish between opioid and nonopioid overdoses.Conclusion: In the United States, transplantation with ODD organs has increased dramatically, with noninferior outcomes in transplant recipients. Concerns about IRD behaviors and hepatitis C among donors lead to excess discard that should be minimized given the current organ shortage.