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英国新的国家肺部分配计划的早期经验基于临床紧急情况

Ahmed Al-Adhami¹, Mohamed Al-Aloul², Sally Rushton³

¹Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridge, UK a.aladhami@gmail.com.

|July 24, 2023

概括

英国肺部分配计划 (UKLAS) 改善了重症患者的肺部移植几率. 虽然紧急病例的等待时间显著减少,但对死亡率和生存的长期影响需要进一步研究.

科学领域:

移植免疫学移植免疫学
肺部医学肺部医学
医疗服务研究医疗服务研究

背景情况:

英国在2017年推出了新的英国肺部分配计划 (UKLAS),取代了地理系统.
UKLAS采用三级系统:超级紧急 (SULAS),紧急 (ULAS) 和非紧急 (NULAS) 的患者优先级.
本研究评估了UKLAS对肺移植等待名单和患者结果的初始影响.

研究的目的:

评估英国肺部分配计划 (UKLAS) 对肺部移植候选人的早期影响.
为了比较UKLAS实施前后的等待列表和移植后的结果.
分析三级紧急系统 (SULAS,ULAS,NULAS) 对移植率和存活率的影响.

主要方法:

一项队列研究,将2015年3月至2016年11月 (时代-1) 的成年肺移植登记与2019年5月至1月 (时代-2) 的成年肺移植登记进行比较.
通过比较两个时代并按紧急级别和诊断组分层来分析结果.
统计分析包括在6个月内移植的几率比率 (OR) 和等待时间,死亡率和生存率的比较.

主要成果:

在第二个时代,有471名患者被注册,其中SULAS为4.0%,ULAS为17.4%,NULAS为78.6%.
在6个月内移植的几率增加了41% (OR=1.41,p=0.0142) 在时代-2相比时代-1.
在2时代,SULAS (8天) 和ULAS (15天) 的中位等待时间大幅减少,但与1时代 (427天) 相比,NULAS (585天) 的等待时间增加了. 等候名单死亡率和移植后的一年生存率在不同时代之间仍然相似.

结论:

在UKLAS有效地优先考虑重症患者,从而提高了肺移植的几率.
该计划显著减少了超紧急和紧急肺移植候选人的等待时间.
需要进一步的长期跟踪,以充分确定UKLAS对等待名单死亡率和移植后存活率的影响.

关键词:

肺部移植肺部移植胸部外科手术胸部外科手术

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