CATCH: Creating Access to Transplant for Candidates who are High Risk

项目总结 今天，终末期肺部疾病患者的肺移植已经变得越来越标准化。 在世界各地，得益于数十年的国际合作和伙伴关系。因此，更多的患者 可以接受挽救生命的程序，并从极大地改善生存和生活质量中受益。 然而，对于三类高危患者来说，获得肺移植的机会仍然特别不同：1) 高度敏感的患者；2)需要体外膜氧合支持的患者 移植(ECMO-BTT)；3)急性呼吸窘迫综合征(ARDS)患者，包括 新冠肺炎相关的ARDS)。因为这些患者并发症的风险很高，而且从历史上看 由于研究不足，对他们的治疗没有明确的指导方针。因此，他们处于独特的劣势： 接受移植在很大程度上取决于他们的计划是否愿意接受没有移植风险的移植 足够的数据来告知如何以最佳和安全的方式执行它。因此，程序不同之处在于 这些患者的选择和管理，造成了显著的差异和不同的护理 中心，最终对移植候选者不利。 在NIH肺移植联盟的支持下，我们建议形成CATCH：Creating Access 为高危候选人进行移植，目标是改善这些人的机会和结果 有需要的病人。组成Catch-University Health Network的四个肺移植项目， 佛罗里达大学、哥伦比亚大学和布里格姆妇女医院-总共表演了400多场 每年进行肺移植，每个人在处理这些患者方面都有广泛但不同的经验。 我们的捕获研究假设是，我们的个人管理策略显著影响高风险 候选人接受移植的可能性及其移植后的结果。通过潜在客户 队列研究，我们的目标是制定一个最佳和统一的战略，以解决特定的未得到满足的需求 这些高危患者。 我们的团队是基于科学价值和战略合作精心组建的，代表着 胸外科和肺移植肺病学的多学科优势将补充我们的 公认的研究领导力。我们在成功的大型项目管理方面拥有丰富的经验 多站点项目，以及我们在开发标准化协议和共识文件方面的专业知识将有所帮助 最大限度地发挥所有移植中心的潜力。最终，作为一个领域的关键舆论领袖，积极 希望得到我们的指导，我们的Catch项目成果将立即 通过标准化领域和确保每个需要肺移植的患者 可以收到一封信。

PROJECT SUMMARY Today, lung transplantation for patients with end-stage lung disease has become increasingly standardized around the world, thanks to decades of international collaboration and partnership. As a result, more patients can receive a life-saving procedure and benefit from vastly improved survival and quality of life. However, access to lung transplant remains particularly variable for three categories of high-risk patients: 1) highly sensitized patients; 2) patients requiring extracorporeal membrane oxygenation support as a bridge to transplant (ECMO-BTT); and 3) patients with acute respiratory distress syndrome (ARDS, including those with COVID-19-associated ARDS). Because these patients are at high-risk for complications and historically understudied, there are no clear guidelines for their treatment. As a result, they are uniquely disadvantaged: receiving a transplant largely depends on their program’s willingness to accept the risk of transplant without sufficient data to inform how it can be optimally and safely performed. Programs, therefore, differ in the selection and management of these patients, creating significant disparities and variation in care across centers, ultimately to the detriment of the transplant candidate. With support from the NIH Lung Transplant Consortium, we propose the formation of CATCH: Creating Access to Transplant for Candidates who are High Risk, with the goal to improve access and outcomes for these patients in need. The four lung transplant programs that comprise CATCH—University Health Network, University of Florida, Columbia University, and Brigham and Women’s Hospital—collectively perform over 400 lung transplantations per year, and each have extensive but differing experience in managing these patients. Our CATCH study hypothesis is that our individual management strategies significantly impact high-risk candidates’ likelihood of receiving a transplant and their post-transplant outcomes. Through prospective cohort studies, we aim to devise an optimal and united strategy that addresses the specific unmet needs of these high risk patients. Our team has been carefully assembled based on scientific merit and strategic collaboration, representing multidisciplinary strengths in thoracic surgery and lung transplant pulmonology that will complement our recognized research leadership. We have extensive experience in successful project management for large multi-site projects, and our expertise in developing standardized protocols and consensus documents will help to maximize the potential across all transplant centers. Ultimately, as key opinion leaders in a field that actively looks to us for guidance, our CATCH project outcomes are strongly positioned to have an immediate transformative impact by standardizing the field and ensuring that every patient in need of a lung transplant can receive one.