Evaluation of Risk Factors for Heart-Lung Transplant Recipient Outcome An Analysis of the United Network for Organ Sharing Database
Evaluation of Risk Factors for Heart-Lung Transplant Recipient Outcome An Analysis of the United Network for Organ Sharing Database
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DOI：
10.1161/circulationaha.119.040682
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发表时间：
2019-10-08
期刊：
影响因子：
37.8
通讯作者：
Woo, Y. Joseph
中科院分区：
文献类型：
--
作者：
Shudo, Yasuhiro;Wang, Hanjay;Woo, Y. Joseph
背景：心肺联合移植（HLTx）是治疗晚期心肺功能衰竭患者的有效方法。然而，没有大型多中心研究关注供体和受体风险因素与HLTx后结局之间的关系。因此，我们使用来自器官共享联合网络数据库的数据调查了这个问题。研究方法：纳入了1987年至2017年期间在器官共享联合网络数据库中登记并接受HLTx的所有成人患者（年龄>= 18岁）（n=997）。我们根据1年时存活且未接受再次移植的患者（n=664）和HLTx后1年内死亡或接受再次移植的患者（n=333）对队列进行分层。主要结局是供体和受体特征对HLTx后1年受体死亡或再次移植的影响。创建Kaplan-Meier曲线以评估总体无死亡或再次移植。为了更好地估计风险和生存时间，选择参数加速失效时间模型进行时间-事件建模分析。结果：HLTx后1年的总移植物存活率为66.6%。在供体中，53%为男性，平均年龄为28.2岁。单变量分析显示，供体高龄、受体男性、受体肌酐、受体既往心脏或肺手术史、受体体外膜肺氧合支持、移植年份和移植中心容量与HLTx后1年死亡或再次移植相关。在多变量分析中，高龄供体（风险比[HR]，1.017; P=0.0007），受体男性（HR，1.701; P=0.0002），受体体外膜氧合支持（HR，4.854; P
Background: Heart-lung transplantation (HLTx) is an effective treatment for patients with advanced cardiopulmonary failure. However, no large multicenter study has focused on the relationship between donor and recipient risk factors and post-HLTx outcomes. Thus, we investigated this issue using data from the United Network for Organ Sharing database. Methods: All adult patients (age >= 18 years) registered in the United Network for Organ Sharing database who underwent HLTx between 1987 and 2017 were included (n=997). We stratified the cohort by patients who were alive without retransplant at 1 year (n=664) and patients who died or underwent retransplant within 1 year of HLTx (n=333). The primary outcome was the influence of donor and recipient characteristics on 1-year post-HLTx recipient death or retransplant. Kaplan-Meier curves were created to assess overall freedom from death or retransplant. To obtain a better effect estimation on hazard and survival time, the parametric Accelerated Failure Time model was chosen to perform time-to-event modeling analyses. Results: Overall graft survival at 1-year post-HLTx was 66.6%. Of donors, 53% were male, and the mean age was 28.2 years. Univariable analysis showed advanced donor age, recipient male sex, recipient creatinine, recipient history of prior cardiac or lung surgery, recipient extracorporeal membrane oxygenation support, transplant year, and transplant center volume were associated with 1-year post-HLTx death or retransplant. On multivariable analysis, advanced donor age (hazard ratio [HR], 1.017; P=0.0007), recipient male sex (HR, 1.701; P=0.0002), recipient extracorporeal membrane oxygenation support (HR, 4.854; P