Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation.
Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation.
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肺移植差异是基于对体外膜氧合移植到移植的患者的诊断。
DOI：
10.1016/j.healun.2021.08.005
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发表时间：
2021-12
影响因子：
8.9
通讯作者：
Benvenuto, Luke
中科院分区：
文献类型：
--
作者：
Furfaro, David;Rosenzweig, Erika B.;Shah, Lori;Robbins, Hilary;Anderson, Michaela;Kim, Hanyoung;Abrams, Darryl;Agerstrand, Cara L.;Brodie, Daniel;Feldhaus, Danielle;Costa, Joseph;Lemaitre, Philippe;Stanifer, Bryan P.;D'Ovidio, Frank;Sonett, Joshua R.;Arcasoy, Selim;Benvenuto, Luke
肺外膜氧合（ECMO）越来越多地被用作肺移植的桥梁，但ECMO状态并没有在肺分配评分（LAS）中明确说明。我们假设在ECMO等待名单中的患者中，肺动脉高压（PAH）患者的移植率较低。使用器官共享联合网络数据，我们对2015年6月1日至2020年6月12日期间年龄≥12岁、活跃在肺移植等待名单上并需要ECMO支持的患者进行了回顾性队列研究。多变量竞争风险分析用于检查等待结果。1064例等待名单受试者需要ECMO支持; 40例（3.8%）患有阻塞性肺病（OLD），97例（9.1%）患有PAH，138例（13.0%）患有囊性纤维化（CF），789例（74.1%）患有间质性肺病（ILD）。最终，671例（63.1%）接受了移植，334例（31.4%）死亡或被除名。ECMO等待名单上的每人年移植率为OLD 15.41，PAH 6.05，CF 15.66，ILD 15.62。与PAH患者相比，OLD、CF和ILD患者在整个研究期间接受移植的可能性分别高出78%、69%和62%（调整后的SHR 1.78 p = 0.007、1.69 p = 0.002和1.62 p = 0.001）。OLD、PAH、CF和ILD在因移植、死亡或除名而从等待名单中移除时的中位LAS分别为75.1、79.6、91.0和88.3（p < 0.001）。在ECMO桥接移植的患者中，PAH患者的移植率低于OLD、CF和ILD患者。
Extracorporcal membrane oxygenation (ECMO) is increasingly utilized as a bridge to lung transplantation, but ECMO status is not explicitly accounted for in the Lung Allocation Score (LAS). We hypothesized that among waitlist patients on ECMO, patients with pulmonary arterial hypertension (PAH) would have lower transplantation rates. Using United Network for Organ Sharing data, we conducted a retrospective cohort study of patients who were ≥12 years old, active on the lung transplant waitlist, and required ECMO support from June 1, 2015 through June 12, 2020. Multivariable competing risk analysis was used to examine waitlist outcomes. 1064 waitlist subjects required ECMO support; 40 (3.8%) had obstructive lung disease (OLD), 97 (9.1%) had PAH, 138 (13.0%) had cystic fibrosis (CF), and 789 (74.1%) had interstitial lung disease (ILD). Ultimately, 671 (63.1%) underwent transplant, while 334 (31.4%) died or were delisted. The transplant rate per person-years on the waitlist on ECMO was 15.41 for OLD, 6.05 for PAH, 15.66 for CF, and 15.62 for ILD. Compared to PAH patients, OLD, CF, and ILD patients were 78%, 69%, and 62% more likely to undergo transplant throughout the study period, respectively (adjusted SHRs 1.78 p = 0.007, 1.69 p = 0.002, and 1.62 p = 0.001). The median LAS at waitlist removal for transplantation, death, or delisting were 75.1 for OLD, 79.6 for PAH, 91.0 for CF, and 88.3 for ILD (p < 0.001). Among patients bridging to transplant on ECMO, patients with PAH had a lower transplantation rate than patients with OLD, CF, and ILD.
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影响因子：
8.9
作者：
Hayanga, J. W. Awori;Hayanga, Heather K.;Abbas, Ghulam
通讯作者：
Abbas, Ghulam
影响因子：
2.5
作者：
Hayanga, Jeremiah A.;Lira, Alena;D'Cunha, Jonathan
通讯作者：
D'Cunha, Jonathan
影响因子：
8.8
作者：
Orens, JB;Shearon, TH;Ardehali, A
通讯作者：
Ardehali, A
影响因子：
6.2
作者：
Benza, Raymond L.;Miller, Dave P.;McGoon, Michael D.
通讯作者：
McGoon, Michael D.
DOI：
10.1053/j.semtcvs.2008.04.004
发表时间：
2008-06-01
影响因子：
2.5
作者：
Hachem, Ramsey R.;Trulock, Elbert P.
通讯作者：
Trulock, Elbert P.