A change of heart: Preliminary results of the US 2018 adult heart allocation revision
A change of heart: Preliminary results of the US 2018 adult heart allocation revision
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DOI：
10.1111/ajt.16010
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发表时间：
2020-06-14
影响因子：
8.8
通讯作者：
Rogers, Joseph G.
中科院分区：
文献类型：
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作者：
Goff, Rebecca R.;Uccellini, Kimberly;Rogers, Joseph G.
2018年，器官采购和移植网络(OPTN)修改了成人心脏分配，以更好地对候选人进行分层，并为医学上最紧急的候选人提供更广泛的机会。我们分析了OPTN数据，包括一年前(Pre：2017年10月18日-2018年10月17日)和之后(Post：2018年10月18日-2019年10月17日)实施的OPTN数据，包括等待名单和移植特征、地理分布和早期结果。成人心脏移植的数量从实施前的2954例增加到实施后的3032例。在后时代，78%的移植是为了医学上最紧急的(状态1-3)，而在前时代，这一比例为68%。供者医院和移植中心之间的中位距离从83海里增加到216海里，总缺血时间从3小时增加到3.4小时(所有P<；.001)。等待名单死亡率在不同时期没有差异(每100个病人年的等待死亡率分别为14.8人年和14.9人年)。移植后患者存活率没有差别，移植前93.6%，移植后92.8%。早期证据表明，心脏分配政策加强了按医疗紧急程度对候选人进行分层，并扩大了对最紧急医疗候选人的分布，对总体等待名单、死亡率和移植后结果的影响最小。
In 2018, the Organ Procurement and Transplantation Network (OPTN) modified adult heart allocation to better stratify candidates and provide broader access to the most medically urgent candidates. We analyzed OPTN data that included waiting list and transplant characteristics, geographical distribution, and early outcomes 1 year before (pre: October 18, 2017-October 17, 2018) and following (post: October 18, 2018-October 17, 2019) implementation. The number of adult heart transplants increased from 2954 pre- to 3032 postimplementation. Seventy-eight percent of transplants in the post era were for the most medically urgent (statuses 1-3) compared to 68% for status 1A in the pre era. The median distance between the donor hospital and transplant center increased from 83 to 216 nautical miles, with an increase in total ischemic time from 3 to 3.4 hours (allP < .001). Waiting list mortality was not different across eras (14.8 vs 14.9 deaths per 100 patient-years pre vs post respectively). Posttransplant patient survival was not different, 93.6% pre and 92.8% post. There is early evidence that the heart allocation policy has enhanced stratification of candidates by their medical urgency and broader distribution for the most medically urgent candidates with minimal impact on overall waiting list mortality and posttransplant outcomes.