Novel Methods to Grow the Impact of Pediatric Thoracic Transplantation

提高儿童胸廓移植影响的新方法

• 批准号: 10186802
• 负责人: David L Morales
• 金额: $ 65.34万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186802
• 关键词: 3-Dimensional; Adult; Benefits and Risks; Cardiac Volume; Chest; Child; Childhood; Clinical Research; Communities; Data; Data Set; Development; Donor person; Effectiveness; Funding; Goals; Heart; Heart Transplantation; Heart-Lung Transplantation; Height; Image; Kidney Transplantation; Knowledge; Life; Lung; Lung Transplantation; Measurement; Methods; Modeling; Organ; Organ Size; Outcome; Patients; Pediatric Hospitals; Policies; Population; Population Sizes; Procedures; Research Personnel; Risk; Sampling; Savings; Standardization; Three-Dimensional Image; Three-Dimensional Imaging; Time; Transplant Recipients; Transplantation; United Network for Organ Sharing; United States National Institutes of Health; Virtual Tool; Wait Time; Waiting Lists; Weight; Work; base; care systems; clinical practice; cohort; design; end-stage organ failure; high risk; human old age (65+); improved; innovation; lung volume; member; models and simulation; mortality; novel; pediatric patients; post-transplant; reconstruction; risk stratification; tool; ventricular assist device; virtual; virtual surgery

Project Summary/Abstract: Pediatric patients in need of thoracic (heart or lung) transplantation suffer unacceptably high mortality on the waitlist, even when there are significant number of donors that go unutilized. Many donors that are determined high-risk and wasted could benefit high-risk recipients that are more likely to die waiting. We propose (Aim 1) development of an innovative risk-based matching of donor and recipient. This will be achieved by developing pediatric specific, donor and recipient risk scoring models for heart and lung transplantation. Risk stratification derived from the scores will then be used in simulation-based models to identify best matching strategy that could deliver optimal overall outcomes for the transplant community (more patients transplanted, shorter waiting time, reduce wait-list mortality and more years of life post-transplant for the community as a whole). Furthermore, pediatric thoracic transplant community is still using an age-old method of weight/height-based donor to recipient size matching which leads to significant number of donors being refused for size mismatch. We also propose (Aim 2) development of in innovative and universally accessible tool for virtual matching of organ size rather than patient size to improve size matching for pediatric thoracic transplantation. This will include development of validated tools for cardiac and lung volume estimation and a clinical study to demonstrate potential benefits of the tool in pediatric heart and lung transplant candidates. Our team has gathered preliminary data to support the premise and feasibility of this project and has the members representing diverse perspective and strengths needed for this project. At the end of this project, we will be able to demonstrate potential benefits of donor- recipient risk matching and organ sizing matching that could improve donor utilization and reduce size mismatch and ultimately improve the impact of pediatric thoracic transplantation.

项目概要/摘要： 需要胸部（心脏或肺）移植的儿科患者在手术后死亡率高得令人无法接受。 等待名单，即使有大量的捐助者没有得到利用。许多捐赠者决心 高风险和浪费的药物可以使高风险的接受者受益，他们更有可能在等待中死去。我们建议（目标1） 发展一种创新的基于风险的捐助者和受援者匹配办法。这将通过开发来实现 儿科特异性，供体和受体的心脏和肺移植的风险评分模型。危险分层 然后将从分数中得出的结果用于基于模拟的模型中，以确定 可以为移植社区提供最佳的整体结果（更多的患者移植，更短的等待时间 时间，减少等待名单的死亡率，并延长整个社区移植后的寿命）。此外，委员会认为， 儿科胸部移植界仍在使用一种基于体重/身高的供体对受体的古老方法 尺寸匹配导致大量供体因尺寸不匹配而被拒绝。我们亦建议 (Aim 2）开发用于器官大小的虚拟匹配的创新和普遍可用的工具，而不是 患者尺寸，以改善小儿胸部移植的尺寸匹配。这将包括发展 用于心脏和肺容量估计的经验证工具以及一项临床研究，以证明 儿科心脏和肺移植候选人的工具。我们的团队已经收集了初步数据来支持 该项目的前提和可行性，并拥有代表不同观点和优势的成员 这个项目需要。在这个项目结束时，我们将能够证明捐助者的潜在好处- 受体风险匹配和器官大小匹配可以提高供体利用率并减少大小不匹配 最终提高小儿胸部移植的效果。