Need for improvements in simultaneous heart-kidney allocation: The limitation of pretransplant glomerular filtration rate.
Need for improvements in simultaneous heart-kidney allocation: The limitation of pretransplant glomerular filtration rate.
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DOI：
10.1111/ajt.16466
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
McElroy LM
中科院分区：
文献类型：
--
作者：
Shaw BI;Samoylova ML;Sanoff S;Barbas AS;Sudan DL;Boulware LE;McElroy LM
在过去的15年中，心脏联合移植(SHK)的发生率显著增加。SHK和单独心脏(HA)移植的适应症没有达成一致，中心的评估过程也有很大的差异。我们利用2003-2017年间移植受者科学登记处的数据来量化SHK实践中的变化，检查SHK与HA的存活率，并确定从SHK获得边际收益的患者。我们使用Kaplan-Meier曲线和Cox比例风险来评估存活率的差异。SHK的发生率在2003至2017年间增加了四倍多，从占心脏移植总数的1.6%增加到6.6%，而接受SHK的透析依赖患者的比例保持不变。SHK与依赖透析的患者的存活率增加有关(SHK12.6vs.HA：7.1年p<；0.0001)，但与非透析依赖患者的存活率(中位数存活率SHK12.5vs.HA12.3，p=0.24)无关。SHK降低死亡风险的边际效应随EGFR的增加而减弱。26%的SHK受者移植肾功能延迟。两种手术的移植后慢性透析相似(HA为6.4%，SHK为6.0%)。需要进一步的研究来确定哪些患者受益于SHK。
The incidence of simultaneous kidney heart transplant (SHK) has increased markedly in the last 15 years. There are no universally agreed upon indications for SHK vs. heart alone (HA) transplant, and center evaluation processes vary widely. We utilized Scientific Registry of Transplant Recipients data from 2003–2017 to quantify changes in the practice of SHK, examine the survival of SHK vs. HA, and identify patients with marginal benefit from SHK. We used Kaplan-Meier curves and Cox proportional hazards to assess differences in survival. The incidence of SHK increased more than four-fold between 2003 and 2017 from 1.6% to 6.6% of total hearts transplanted, while the proportion of dialysis-dependent patients undergoing SHK has remained constant. SHK was associated with increased survival in dialysis-dependent patients (Median Survival SHK: 12.6 vs. HA: 7.1 years p<0.0001) but not non-dialysis-dependent patients (Median Survival SHK: 12.5 vs. HA 12.3, p=0.24). The marginal effect of SHK in decreasing the hazard of death diminished with increasing eGFR. Delayed graft function occurred in 26% of SHK recipients. Post-transplant chronic dialysis was similar for both operations (6.4% of HA and 6.0% of SHK). Further study is needed to define patients that benefit from SHK.
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影响因子：
8.8
作者：
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通讯作者：
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影响因子：
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作者：
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作者：
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作者：
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通讯作者：
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DOI：
10.1016/j.jtcvs.2017.11.087
发表时间：
2018-04-01
影响因子：
6
作者：
Kolsrud, Oscar;Karason, Kristjan;Dellgren, Goran
通讯作者：
Dellgren, Goran