Extracorporeal Membrane Oxygenation Bridge to Heart-Lung Transplantation
Extracorporeal Membrane Oxygenation Bridge to Heart-Lung Transplantation
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DOI：
10.1097/mat.0000000000001457
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发表时间：
2022-03-01
期刊：
影响因子：
4.2
通讯作者：
Woo, Y. Joseph
中科院分区：
文献类型：
--
作者：
Shudo, Yasuhiro;Elde, Stefan;Woo, Y. Joseph
体外膜肺氧合（ECMO）是一种多功能的机械循环支持技术，可用作挽救治疗，以减轻终末器官功能障碍，并可能作为移植的桥梁。2然而，在一项利用联合器官共享网络（UNOS）数据库的研究中，约1,000例接受HLTx的患者，移植前ECMO被证明是死亡或再次移植的重要预测因素。[3] 2018年10月，UNOS改变了美国的心脏分配政策。4引入了更多类别，以更好地将心脏移植受者的紧急程度从3类（状态1A，1B和2）分为6类（状态1-6）。由于HLTx候选者在新系统中通常被列为状态4或5（而不是在先前系统中列为状态1B或2），因此预计ECMO作为HLTx桥梁的作用将增加。因此，本研究的目的是使用斯坦福大学数据库审查ECMO作为HLTx的桥梁的影响。我们回顾性分析了2013年1月至2020年6月期间在斯坦福大学医院接受HLTx的所有患者。根据移植前ECMO放置作为HLTx的桥梁的要求，将患者分为两组。基线人口统计学包括年龄、性别、体重指数（kg/m2）、血型、初步诊断、高血压、糖尿病、冠状动脉疾病、血液透析、慢性阻塞性肺疾病（COPD）、植入式心律转复除颤器（ICD）、斯托克史、既往胸骨切开术史和吸烟史。术中数据包括总同种异体移植物缺血时间、热缺血时间、心肺转流时间和阻断时间。术后结果包括住院时间和重症监护室住院时间、30天、1年、3年、5年和总死亡率，涉及该数据集的研究被认为免于斯坦福大学医学院机构审查委员会的审查。连续变量表示为平均值±标准差，通过非参数Wilcoxon秩和检验评价组间差异。分类变量比较采用χ2检验。使用Kaplan-Meier方法构建生存曲线，按移植前ECMO使用情况分层，并通过对数秩检验进行检验。p值< 0.05被认为是统计学显著的。所有分析均使用SAS 9.4版（SAS Institute Inc.，卡里，北卡罗来纳州）。
Extracorporeal membrane oxygenation (ECMO) is a versatile mechanical circulatory support technique that may be used as salvage therapy to mitigate end-organ dysfunction and potentially serve as a bridge to transplantation. 2 Nevertheless, in a study utilizing the United Network of Organ Sharing (UNOS) database of about 1,000 patients undergoing HLTx, pretransplant ECMO was shown to be a significant predictor of death or retransplantation. 3 The UNOS changed the heart allocation policy in the United States in October 2018. 4 More categories were introduced to better stratify the urgency for recipients of heart transplants from three categories (status 1A, 1B, and 2) to 6 categories (status 1–6). Because HLTx candidates are normally listed as status 4 or 5 in the new system (rather than as status 1B or 2 in the prior system), the role of ECMO as a bridge to HLTx is anticipated to increase. Thus, the aim of this study was to review the impact of ECMO as a bridge to HLTx using the Stanford University Database. We retrospectively reviewed all patients who underwent HLTx at Stanford University Hospital between January 2013 and June 2020. Patients were divided into two groups based on the requirement of pretransplant ECMO placement as a bridge to HLTx. Baseline demographics comprised age, sex, body mass index (kg/m2), blood type, primary diagnosis, history of hypertension, diabetes, coronary artery disease, hemodialysis, chronic obstructive pulmonary disease (COPD), implantable cardioverter defibrillator (ICD), history of stoke, history of previous sternotomy, and history of tobacco usage. Intraoperative data comprised total allograft ischemic time, warm ischemic time, cardiopulmonary bypass time, and cross-clamp time. Postoperative outcomes comprised length of hospital and intensive care unit stays, and 30 day, 1 year, 3 year, 5 year, and overall mortality.Studies involving this dataset are considered exempt from review by the Institutional Review Board of the Stanford University School of Medicine. Continuous variables are presented as mean±standard deviation, and differences between groups were evaluated by nonparameteric Wilcoxon rank sum test. The χ2 test was used to compare categorical variables. Survival curves were constructed using the Kaplan–Meier method, stratified by pretransplant ECMO usage, and tested by the log-rank test. p values< 0.05 were considered statistically significant. All analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC).