National Trends in Extended Criteria Donor Utilization and Outcomes for Lung Transplantation
National Trends in Extended Criteria Donor Utilization and Outcomes for Lung Transplantation
复制标题
DOI：
10.1016/j.athoracsur.2020.05.087
复制
发表时间：
2021-01-21
影响因子：
4.6
通讯作者：
Sanchez, Pablo G.
中科院分区：
文献类型：
--
作者：
Christie, Ian G.;Chan, Ernest G.;Sanchez, Pablo G.
背景由于供体器官短缺，肺移植（LTx）的扩展标准供体（ECD）已经实施。对接受者生存的影响正在调查中。我们报告了现代使用扩展标准肺的趋势及其与使用大型国家数据库的生存结果的相关性。我们使用器官共享联合网络数据库对2005年5月至2018年12月的所有成人LTx进行了回顾性分析。ECD的定义是与标准标准有2个或2个以上的差异：年龄≥ 55岁，pO 2 = 20，糖尿病，化脓性支气管镜检查，血液感染或胸片异常。移植中心根据体积进行二分。以肺分配评分作为协变量分析肺转移生存率。在24，888例LTx中，80%有扩展标准; 42%有2次或2次以上扩展，在本分析中被视为ECD。在研究期间，LTx量（2005年：1352; 2018年：2495）和ECD使用量（2005年：27%ECD，2018年：50%ECD）均有所增加。LTx接受者的生存率稳步上升（2005年：82%的1年生存率; 2017年：90%的1年生存率）。高容量中心（>47例年度LTx）在46%的移植中使用了ECD，而其他中心为40%。ECD和标准器官移植的1年生存率无差异。供体供应限制了进行LTx的次数。随着LTx总量的增加，供体标准也随之扩大。使用ECD并不影响30天、90天或1年生存率。需要进一步的研究来确定长期结果。(C)2021年美国胸外科医师协会
Background. Extended criteria donor (ECD) for lung transplantation (LTx) have been implemented due to the donor organ shortage. The impact on recipient survival is under investigation. We report trends in the use of extended criteria lungs in the modern era and its association with survival outcomes using a large national database.Methods. We performed a retrospective analysis of all adult LTx from May 2005 to December 2018 using the United Network for Organ Sharing database. ECD were defined by 2 or more variances from standard criteria: age >= 55 years, pO2 = 20, diabetes, purulent bronchoscopy, blood infection, or abnormal chest radiographs. Transplant centers were dichotomized based on volume. Recipient survival was analyzed using lung allocation score as a covariate.Results. Of 24,888 LTx, 80% had extended criteria; 42% had 2 or more extensions and were deemed ECD in this analysis. Both LTx volume (2005: 1352; 2018: 2495) and use of ECD (2005: 27% ECD, 2018: 50% ECD) have increased over the study period. Survival of LTx recipients has steadily increased (2005: 82% 1-year survival in 2005; 2017: 90% 1-year survival). High-volume centers (>47 annual LTx) utilized ECD in 46% of transplants compared with 40% ECD among other centers. Recipients of ECD and standard criteria organs had no difference in 1-year survival.Conclusions. Donor supply limits the number of LTx performed. Extension of donor criteria has occurred alongside increased overall LTx volume. Use of ECD did not compromise 30-day, 90-day, nor 1-year survival. Further studies are warranted to define long-term outcomes. (C) 2021 by The Society of Thoracic Surgeons