Local Allocation of Lung Donors Results in Transplanting Lungs in Lower Priority Transplant Recipients
Local Allocation of Lung Donors Results in Transplanting Lungs in Lower Priority Transplant Recipients
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DOI：
10.1016/j.athoracsur.2012.11.070
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发表时间：
2013-04-01
影响因子：
4.6
通讯作者：
Gibbons, Robert
中科院分区：
文献类型：
--
作者：
Russo, Mark J.;Meltzer, David;Gibbons, Robert
背景。在目前的肺分配系统下，如果当地供体服务区（DSA）内的候选人接受器官，则永远不会将器官提供给可能病情更严重的更广泛区域级别的候选人，即使非本地候选人具有更高的肺分配分数（LAS）。本研究的目的是确定在同一区域存在具有较高 LAS 的血型匹配和尺寸匹配候选者时，器官分配给当地肺受体的频率。方法。器官共享联合网络 (UNOS) 提供了去识别化的患者级别数据。研究人群包括 2009 年在美国进行的双肺移植 (DLT) 的所有本地分配器官 (n = 580)。计算同一区域内所有 ASO 血型匹配、身高匹配（+/- 10 cm）、双肺候选者的出现情况，其 LAS 高于实际接受器官的当地候选者；这些事件被称为事件。结果。 2009 年，当本地 DLT 接收者候选者收到 DLT 而同一地区的 DLT 候选者具有较高 LAS 时，发生了 3,454 起事件。每次移植平均发生 5.96 个事件，这影响了 580 个 DLT 中的 480 个 (82.8%)。此外，其中 555 起（16.1%）事件涉及 185 名地区候选人中的 1 名（或更多），他们最终没有接受移植并在等待名单上死亡。结论。该分析表明，基于本地的肺分配系统导致高频率的事件，其中器官被分配给较低优先级候选者，而区域上存在适当匹配的较高优先级候选者。 (Ann Thorac Surg 2013;95:1231-5) (C) 2013，胸外科医师协会
Background. Under the current lung allocation system, if organs are accepted for a candidate within the local donor service area (DSA), they are never offered to candidates at the broader regional level who are potentially more severely ill, even if the nonlocal candidate has a higher lung allocation score (LAS). The purpose of this study was to determine the frequency with which organs were allocated to a local lung recipient while a blood group-matched and size-matched candidate with a higher LAS existed in the same region.Methods. United Network for Organ Sharing (UNOS) provided deidentified patient-level data. The study population included all locally allocated organs for double-lung transplants (DLTs) performed in 2009 in the United States (n = 580). All occurrences of an ASO blood group-matched, height-matched (+/- 10 cm), double-lung candidate in the same region, with a higher LAS than the local candidate who actually received the organs, were calculated; these occurrences were termed events.Results. In 2009, 3,454 events occurred when a local DLT recipient candidate received a DLT while a DLT candidate in the same region had a higher LAS. With a mean of 5.96 events per transplant, this impacted 480 (82.8%) of the 580 DLTs. Further, 555 (16.1%) of these events involved 1 (or more) of the 185 regional candidates who ultimately did not receive transplants and died while on the waiting list.Conclusions. This analysis suggests that the locally based lung allocation system results in a high frequency Of events whereby an organ is allocated to a lower-priority candidate while an appropriately matched higher priority candidate exists regionally. (Ann Thorac Surg 2013;95:1231-5) (C) 2013 by The Society of Thoracic Surgeons