Revised Heart Allocation Policy Improved Waitlist Mortality and Waiting Time With Maintained Outcomes in En-Bloc Heart-Lung Transplant Candidates and Recipients.
Revised Heart Allocation Policy Improved Waitlist Mortality and Waiting Time With Maintained Outcomes in En-Bloc Heart-Lung Transplant Candidates and Recipients.
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DOI：
10.3389/ti.2023.11956
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发表时间：
2023
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修订后的联合器官共享网络心脏分配政策于2018年10月实施。使用国家移植数据库，本研究评估了移植率、等待名单死亡率、等待时间和整体心肺移植受者的其他结果。选择在政策更新前后在国家心肺移植数据库中登记的成年患者作为队列。基线特征、移植率、等待名单死亡率、等待时间和其他结果在两个时期之间进行比较。总共有370名患者在术前和术后登记进行心肺移植。移植率显著提高，等候时间缩短，等候期死亡率显著降低。术后等待登记的患者对主动脉内球囊泵、体外膜氧合和包括心室辅助装置在内的整体生命支持的使用率明显更高。移植受者的缺血时间明显延长，运输距离增加，移植前等待时间缩短。移植受者在政策改变前后的短期生存率相似（log-rank检验，p = 0.4357）。因此，与之前的政策相比，修订后的政策显着改善了整体心肺移植的可及性，具有更好的等待名单结果和类似的移植后结果。
The revised United Network for Organ Sharing heart allocation policy was implemented in October 2018. Using a national transplant database, this study evaluated the transplant rate, waitlist mortality, waiting time, and other outcomes of en-bloc heart-lung transplantation recipients. Adult patients registered on the national database for heart-lung transplants before and after the policy update were selected as cohorts. Baseline characteristics, transplant rates, waitlist mortality, waiting times, and other outcomes were compared between the two periods. In total, 370 patients were registered for heart-lung transplants during the pre- and post-periods. There were significantly higher transplant rates, shorter waitlist times, and substantially reduced waitlist mortality in the post-period. Registered patients waitlisted in the post-period had significantly higher utilization of intra-aortic balloon pumps, extracorporeal membrane oxygenation, and overall life support, including ventricular assist devices. Transplant recipients had significantly longer ischemic times, increased transport distances, and shorter waiting times before transplantation in the post-policy period. Transplant recipients held similar short-term survival before and after the policy change (log-rank test, p = 0.4357). Therefore, the revised policy significantly improved access to en-bloc heart-lung allografts compared with the prior policy, with better waitlist outcomes and similar post-transplant outcomes.
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影响因子：
1.6
作者：
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158.5
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