Extracorporeal membrane oxygenation support and post-heart transplant outcomes among United States adults
Extracorporeal membrane oxygenation support and post-heart transplant outcomes among United States adults
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DOI：
10.1016/j.healun.2016.10.008
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发表时间：
2017-01-01
影响因子：
8.9
通讯作者：
Lindenfeld, JoAnn
中科院分区：
文献类型：
--
作者：
Zalawadiya, Sandip;Fudim, Marat;Lindenfeld, JoAnn
背景：接受体外膜肺氧合（ECMO）支持的患者被给予心脏移植（HT）的优先列表状态。数据HT后的结果与ECMO支持的成年人在HT的时间是limited.METHODS：我们分析了数据从联合网络器官登记处（UNOS）注册为157 ECMO支持的成年人（年龄>= 18岁）进行HT后，2000年1月1日。HT时的数据与移植后死亡率的相关性进行了多变量考克斯比例风险分析。结果：患者（69.4%男性，平均年龄46.0 +/- 15.6岁，15.9%非裔美国人）进行了监测，中位数为0.55年（四分位数间距，0.04-4.5）。70例（44.6%）患者在随访期间死亡（1年生存率为57.8%），其中43例（61.4%）在HT后30天内死亡。对于移植后前30天存活的患者，长期生存率是可以接受的（第1年为82.3%，第5年为76.2%）。HT后即刻并发症（如卒中和需要透析）的患病率分别为10.1%和28.1%。在2009年1月1日之前和之后接受同种异体移植的患者之间，HT后生存率没有差异（单变量风险比，0.84; 95%置信区间，0.51-1.38; p = 0.48）。在30天和长期死亡率的预测因素中，受者有肾功能不全史（RI;定义为估计的肾小球滤过率< 45 ml/min/1.73 m2或透析）和机械通气（MV;相互作用p < 0.05）;那些同时患有MV和RI的患者的移植后存活率明显较差，（30天和1年生存率分别为29.4%和12.5%）（30天和1年生存率分别为78.7%和71.4%）。在当代，ECMO支持的成人HT后死亡率没有改变，RI和MV患者的移植后生存率明显较差。对ECMO支持的患者的优先列表状态进行严格审查，以获得心脏同种异体移植物的最佳分配和结局。(C)2016年国际心肺移植学会。All rights reserved.
BACKGROUND: Patients supported with extracorporeal membrane oxygenation (ECMO) are given priority listing status for heart transplant (HT). Data on post-HT outcomes for adults with ECMO support at the time of HT are limited.METHODS: We analyzed data from the United Network for Organ Registry (UNOS) registry for 157 ECMO-supported adults (age >= 18 years) undergoing HT after January 1, 2000. Data at the time of HT were examined for their association with post-transplant mortality using multivariable Cox proportional hazard analyses.RESULTS: Patients (69.4% males; mean age, 46.0 +/- 15.6 years; 15.9% African Americans) were monitored for median of 0.55 years (interquartile range, 0.04-4.5). Seventy patients (44.6%) died during follow-up (survival at I year was 57.8%), of which 43 (61.4%) died within 30 days post-HT. For patients surviving the first 30 days after transplant, long-term survival was acceptable (82.3% at I year and 76.2% at 5 years). Prevalence of immediate post-HT complications, such as stroke and need for dialysis, were 10.1% and 28.1%, respectively. Post-HT survival did not differ between those who received an allograft before and after January I, 2009 (univariate hazard ratio, 0.84; 95% confidence interval, 0.51-1.38; p = 0.48). Among the predictors identified for 30-day and long-term mortality were recipient history of renal insufficiency (RI; defined as estimated glomerular filtration rate < 45 ml/min/1.73 m(2) or dialysis) and mechanical ventilation (MV; interaction p < 0.05); those with both MV and RI had significantly poorer post-transplant survival (29.4% and 12.5% for 30-day and I-year survival, respectively) compared with those without (78.7% and 71.4% for 30-day and I-year survival, respectively).CONCLUSIONS: Post-HT mortality did not change for ECMO-supported adults in the contemporary era, and those with RI and MV had significantly poorer post-transplant survival. A critical review of priority listing status for ECMO-supported patients is warranted for optimal allocation and outcomes of cardiac allografts. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.