Center Volume and Extracorporeal Membrane Oxygenation Support at Lung Transplantation in the Lung Allocation Score Era
Center Volume and Extracorporeal Membrane Oxygenation Support at Lung Transplantation in the Lung Allocation Score Era
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DOI：
10.1164/rccm.201511-2222oc
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发表时间：
2016-08-01
影响因子：
24.7
通讯作者：
Tumin, Dmitry
中科院分区：
文献类型：
--
作者：
Hayes, Don, Jr.;Tobias, Joseph D.;Tumin, Dmitry
理由：在移植专业知识中心差异的情况下，用于桥接患者与肺移植的体外膜氧合 (ECMO) 相关的结果尚未进行调查。目的：确定移植时 ECMO 对在历史上低容量和高容量中心接受移植手术的成年患者的生存的影响。方法：使用器官共享联合网络数据库 根据 2005 年 5 月至 2010 年 5 月期间的移植量将中心分类为低容量中心（中心的底部 50%）、中等容量中心（接下来的 25%）或高容量中心（顶部 25%）。根据过去 5 年的历史中心体积，估算了 2010 年 6 月至 2015 年 6 月期间接受肺移植的成人中 ECMO 对移植后存活率的影响。测量和主要结果：根据 2005 年至 2010 年的肺移植体积对 65 个中心进行分类，其中 2010 年 6 月至 2015 年 6 月期间在这些中心接受移植的 8,228 名成人（279 名使用 ECMO）纳入研究范围。 生存分析。在按中心分层的多变量 Cox 分析中，我们发现，在历史上容量较低的中心，ECMO 与移植后死亡风险增加相关（风险比，1.968；95% 置信区间，1.083-3.577；P = 0.026）。相比之下，在历史上高容量中心，ECMO 对移植后生存没有不利影响（风险比，0.853；95% 置信区间，0.596-1.222；P = 0.386）。结论：肺移植时 ECMO 的不利影响在低容量中心中很明显，但在有超过 170 次肺移植经验的中心中不存在。 肺分配评分时代前 5 年的移植。
Rationale: Outcomes related to extracorporeal membrane oxygenation (ECMO) used to bridge patients to lung transplantation in the context of center differences in transplant expertise have not been investigated.Objectives: To determine the effects of ECMO at time of transplant on survival in adult patients who underwent transplant surgery in historically low-and high-volume centers.Methods: The United Network for Organ Sharing database was used to classify centers according to transplant volume between May 2005 and May 2010 as low-volume centers (bottom 50% of centers), medium-volume centers (next 25%), or high-volume centers (top 25%). Influences of ECMO on post-transplant survival were estimated among adults receiving lung transplants between June 2010 and June 2015 based on historic center volume in the preceding 5 years.Measurements and Main Results: Sixty-five centers were classified according to lung transplant volume in 2005-2010, with 8,228 adults (279 on ECMO) who underwent transplants at these centers between June 2010 and June 2015 included in the survival analysis. In multivariable Cox analysis stratified by center, we found that, in historically low-volume centers, ECMO was associated with increased post-transplant mortality hazard (hazard ratio, 1.968; 95% confidence interval, 1.083-3.577; P = 0.026). In contrast, in historically high-volume centers, ECMO had no adverse influence on post-transplant survival (hazard ratio, 0.853; 95% confidence interval, 0.596-1.222; P = 0.386).Conclusions: An adverse effect of ECMO at the time of lung transplant was evident in low-volume centers but absent in centers with experience of performing more than 170 lung transplants in the first 5 years of the lung allocation score era.