Wait-List Outcomes for Adults With Congenital Heart Disease Listed for Heart Transplantation in the US
Wait-List Outcomes for Adults With Congenital Heart Disease Listed for Heart Transplantation in the US
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DOI：
10.1016/j.jacc.2016.05.082
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发表时间：
2016-08-30
影响因子：
24
通讯作者：
Bartlett, Heather L.
中科院分区：
文献类型：
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作者：
Alshawabkeh, Laith I.;Hu, Nan;Bartlett, Heather L.
背景技术对于许多患有先天性心脏病(ACHD)的成年人来说，心力衰竭是一种常见的终末期综合征。然而，这些患者已被排除在大多数心脏移植研究之外。目前尚不清楚当前用于确定移植列表时优先级的标准（源自非 ACHD 人群）如何影响列入心脏移植名单的 ACHD 患者的结局。 目的 本研究的目的是调查 ACHD 患者与列入心脏移植名单的非 ACHD 患者的结局相比。 方法 我们使用移植受者科学登记系统对 >= 的患者进行了一项回顾性研究 1999 年至 2014 年间在美国列出的 18 岁患者。使用累积发生率函数估计因临床恶化而死亡或除名的概率，其中移植是竞争事件。结果 在列出的 1,290 名 ACHD 患者和 38,557 名非 ACHD 患者中，237 名 ACHD 患者和 6,377 名非 ACHD 患者因临床恶化死亡或被除名。对于最初列为 1A 状态的 ACHD 患者，死亡或因临床恶化而被除名的可能性更大（180 天后，ACHD 患者为 24%，非 ACHD 患者为 17%；p < 0.001）。 ACHD 和列为 1B 或 2 状态的非 ACHD 患者之间没有显着差异。在多变量分析中，由于 ACHD 1 年内临床恶化而导致死亡或除名的相关因素包括：估计肾小球滤过率 < 60 ml/min/1.73 m(2)（风险比 [HR]：1.4；95% 置信区间 [CI]：1.0 至 1.9；p = 0.043）；白蛋白
BACKGROUND Heart failure represents a common end-stage syndrome for many adults with congenital heart disease (ACHD). These patients, however, have been excluded from most heart transplantation research. It is not known how current criteria, derived from non-ACHD populations, used to determine priority at the time of transplant listing, impact the outcomes for ACHD patients listed for heart transplantation.OBJECTIVES The goal of this study was to investigate outcomes of ACHD in comparison to non-ACHD patients while listed for heart transplantation.METHODS We conducted a retrospective study using the Scientific Registry of Transplant Recipients on patients >= 18 years of age listed in the United States between 1999 and 2014. The probability of mortality or delisting due to clinical worsening was estimated using cumulative incidence functions, where transplantation was a competing event.RESULTS Among 1,290 ACHD and 38,557 non-ACHD patients listed, 237 ACHD and 6,377 non-ACHD patients died or were delisted due to clinical worsening. Death or delisting for clinical worsening was more likely for ACHD patients initially listed as status 1A (24% ACHD vs. 17% non-ACHD after 180 days; p < 0.001). There were no significant differences between ACHD and non-ACHD patients listed as status 1B or 2. In multivariable analysis, factors associated with death or delisting due to clinical worsening within 1 year in ACHD included: estimated glomerular filtration rate < 60 ml/min/1.73 m(2) (hazard ratio [HR]: 1.4; 95% confidence interval [CI]: 1.0 to 1.9; p = 0.043); albumin