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

CATCH：为高风险候选人创造移植机会

• 批准号: 10430882
• 负责人: Meghan M Aversa
• 金额: $ 40.47万
• 依托单位: UNIVERSITY HEALTH NETWORK
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10430882
• 关键词: Acute Respiratory Distress Syndrome; Address; Affect; Age; Body mass index; Boston; COVID-19; COVID-19/ARDS; Caring; Categories; Cells; Clinical; Collaborations; Complement; Consensus; Critical Illness; Data; Disadvantaged; Donor person; Eligibility Determination; Ensure; Exercise; Extracorporeal Membrane Oxygenation; Florida; Future; Goals; Guidelines; Health; Hospitals; Immunosuppression; Improve Access; Individual; International; Leadership; Length of Stay; Life; Lung; Lung Transplantation; Lung diseases; Mechanical ventilation; Mechanics; New York; Operative Surgical Procedures; Outcome; Patient Participation; Patient-Focused Outcomes; Patients; Perioperative; Physical therapy; Positioning Attribute; Predictive Factor; Procedures; Process; Prospective cohort study; Protocols documentation; Pulmonology; Quality of life; Regimen; Research; Risk; Savings; Sedation procedure; Selection Criteria; Site; Standardization; Thoracic Surgical Procedures; Time; Transplant Recipients; Transplantation; Uncertainty; United States National Institutes of Health; Universities; Variant; Waiting Lists; Walking; Woman; antibody-mediated rejection; base; candidate selection; desensitization; donor-specific antibody; experience; graft dysfunction; health related quality of life; high risk; improved; improved outcome; mortality; multidisciplinary; organ allocation; post-transplant; programs; transplant centers; virtual; willingness

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.

项目摘要 如今，针对终末期肺病患者的肺移植已日趋规范 在世界各地，由于几十年的国际合作和伙伴关系。结果，更多的患者 可以接受挽救生命的手术，并从大大改善的生存和生活质量中受益。 然而，对于三类高危患者而言，肺移植的可及性仍然存在很大差异：1） 高度致敏患者; 2）需要体外膜氧合支持作为桥梁的患者， 移植（ECMO-BTT）; 3）急性呼吸窘迫综合征（ARDS）患者， COVID-19相关ARDS）。因为这些病人有很高的并发症风险， 研究不足，没有明确的指导方针，他们的治疗。因此，他们处于特殊的不利地位： 接受移植在很大程度上取决于他们的项目是否愿意接受移植的风险，而不 足够的数据来告知如何最佳和安全地执行。因此，方案在 这些患者的选择和管理，造成了护理的显著差异和变化， 中心，最终对移植候选人不利。 在NIH肺移植联盟的支持下，我们建议成立CATCH：创建通路 为高风险的候选人移植，目的是改善这些人的获得和结果。 病人需要。组成CATCH大学健康网络的四个肺移植项目， 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 肺移植，每个人都有广泛的，但不同的经验，在管理这些病人。 我们的CATCH研究假设是，我们的个人管理策略显着影响高风险 候选人接受移植的可能性及其移植后的结果。通过前瞻性 通过队列研究，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， 在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。我们在大型项目的成功管理方面拥有丰富的经验， 多站点项目，以及我们在制定标准化协议和共识文件方面的专业知识， 以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意见领袖， 期待着我们的指导，我们的CATCH项目成果是坚定的立场，有一个立即 通过标准化该领域并确保每一位需要肺移植的患者 可以接收一个。