Exception Status Listing in the New Adult Heart Allocation System: A New Solution to an Old Problem?
Exception Status Listing in the New Adult Heart Allocation System: A New Solution to an Old Problem?
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新的成人心脏分配系统中的例外状态清单：解决旧问题的新解决方案？
DOI：
10.1161/circheartfailure.120.007916
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Uriel N
中科院分区：
文献类型：
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作者：
Topkara VK;Clerkin KJ;Fried JA;Griffin J;Raikhelkar J;Hi Lee S;Latif F;Habal M;Horn E;Farr MA;Takada K;Naka Y;Jorde UP;Sayer G;Uriel N
经过修订的6层美国成人心脏分配政策的目标之一是改善患者的风险分层，以降低异常状态利用用于移植清单。
该联合器官共享网络（UNOS）数据库的回顾性队列分析包括成人等待名单患者的心脏移植，2018年10月18日至2020年6月30日在美国，通过使用异常状态与标准标准进行了分层。
1907年（3351名患者在例外状态下都被列出。与标准标准（HR：1.25 [1.15-1.38]，p <0.001）相比，心脏移植的事件明显更高，而多分变可调整后，没有增加死亡风险或担心临床状态的死亡风险或降级临床状态（HR：0.83 [0.65-1.05]，p = 0.12）。
正如移植医师和审查委员会所评估的那样，新的心脏分配系统的状态层可能无法完全捕捉候补患者的医疗紧迫性和复杂性，这可能会限制发展心脏分配评分的能力。
One of the goals of the revised 6-tiered United States adult heart allocation policy was to improve risk stratification of patients in order to lower exception status utilization for transplant listing. We sought to define the characteristics and outcomes of waitlisted patients using exception status and to examine region- and center- level differences in utilization of exception status in the new heart allocation system. This retrospective cohort analysis of the United Network for Organ Sharing (UNOS) database included adult waitlisted patients for heart transplant between October 18, 2018 and June 30, 2020 in the United States, stratified by use of exception status versus standard criteria. 1907 (30.0%) out of 6351 patients were waitlisted under exception status. Patients using exception status were more likely to have a non-ischemic etiology of heart failure, blood type O, UNOS Status 2 at listing, and were less likely to have a durable left ventricular assist device at listing. Exception status utilization varied significantly between and within UNOS regions. Listing by exception criteria was associated with a significantly higher incidence of heart transplantation compared to listing by standard criteria (HR: 1.25 [1.15–1.38], p <0.001), without increased risk of death or delisting for worsening clinical status (HR: 0.83 [0.65–1.05], p=0.12) after multivariable adjustment. The status tiers of the new heart allocation system may not fully capture medical urgency and complexity of waitlisted patients as assessed by transplant physicians and review committees and which may limit the ability to develop a heart allocation score.