Organ allocation in adults with congenital heart disease listed for heart transplant: Impact of ventricular assist devices
Organ allocation in adults with congenital heart disease listed for heart transplant: Impact of ventricular assist devices
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DOI：
10.1016/j.healun.2013.06.024
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发表时间：
2013-11-01
影响因子：
8.9
通讯作者：
Broberg, Craig S.
中科院分区：
文献类型：
--
作者：
Gelow, Jill M.;Song, Howard K.;Broberg, Craig S.
背景：成人先天性心脏病（CHD）被列为心脏移植患者很少使用心室辅助装置（vad）。这可能不利于他们优先分配器官。我们试图确定VAD植入与心脏移植成功之间的关系。方法：从1985年至2010年的联合器官共享网络（LINOS）数据库中确定成人CUD患者（N = 1250），并将其与无先天性心力衰竭病因的患者（N = 59,606）进行比较。VAD在移植前上市时的使用情况、上市状态、状态升级和升级原因每隔5年进行趋势分析，并在组间进行适当的统计比较。结果：自1985年以来，移植前VAD的使用在没有CM的患者中显著增加，但在CID患者中没有（2006年为17%，2010年为3%，p < 0.0001）。与未被列入状态2的患者相比，CUD患者更有可能被列为状态2(2006年至2010年，66%对40%，p < 0.001)，在列入状态1后，升级到状态1的可能性较小（43%对55%，p = 0.03）。在状态1升级的患者中，CUD患者在移植时发生VAD的可能性低于未升级的患者（3% vs 18%, p = 0.005）。使用VAD更容易导致CUD患者死亡。结论：无论是在上市时还是移植时，VAD在CUD患者中的使用都比没有CID的患者少。VAD使用的减少似乎有助于降低清单地位和器官分配。随着时间的推移，这些差异变得越来越不同。CUD患者器官分配的单独标准可能是合理的。(C) 2013年国际心肺移植学会。版权所有。
BACKGROUND: Adults with congenital heart disease (CHD) listed for heart transplantation are rarely supported by ventricular assist devices (VADs). This may be a disadvantage to their priority for organ allocation. We sought to determine the relationship between VAD implantation and successful transplantation among patients listed for heart transplant.METHODS: Adults with CUD patients (N = 1,250) were identified from the United Network for Organ Sharing (LINOS) database from 1985 to 2010 and compared to patients without congenital etiology for heart failure (N = 59,606). VAD use at listing, listing status, status upgrades and reasons for upgrade prior to transplant were trended at 5-year intervals and appropriate statistical comparisons were made between groups.RESULTS: Since 1985, VAD use prior to transplant has increased significantly in patients without CM, but not in CID patients (17% vs 3% in 2006 to 2010, p < 0.0001). CUD patients were more likely to be listed as Status 2, compared to those without (66% vs 40%, p < 0.001 for 2006 to 2010), and less likely to be upgraded to Status 1 after listing (43% vs 55%, p = 0.03). Among those upgraded to Status 1, CUD patients were less likely to have a VAD at transplant than those without (3% vs 18%, p = 0.005). VAD use was more likely to result in death in CUD patients.CONCLUSIONS: VAD use is less common in CUD patients than in patients without CID, both at the time of listing and transplantation. Reduced VAD use appears to contribute to lower listing status and organ allocation. These differences have grown more disparate over time. Separate criteria for organ allocation for CUD patients may be justified. (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.