在心脏移植中使用更远距离捐赠者的中心水平的变化正在演变
Krishna Bhandari1, Khaled Shorbaji1, Akinwale Victor Famotire1
1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29425, United States.
Interdisciplinary cardiovascular and thoracic surgery
|August 18, 2025
概括
在心脏移植 (HT) 中使用长距离捐赠者 (LDD) 在2018年政策变化后显著增加. 使用LDD的HT接受者的生存结果明显好于非LDD,挑战了关于捐赠者距离和缺血时间的先前假设.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 公共卫生政策 公共卫生政策
背景情况:
- 2018年分配政策的变化旨在优化心脏移植 (HT) 中器官利用率.
- 了解捐赠者旅行距离增加对HT结果的影响至关重要.
研究的目的:
- 评估2018年政策变化之前和之后对HT使用长距离捐赠者 (LDD) 的变化.
- 评估LDD使用对心脏移植后患者存活率的影响.
主要方法:
- 从美国器官共享网络登记处分析成年HT接受者 (2010-2023年).
- 使用曼-肯德尔测试和倾向匹配生存分析 (卡普兰-梅尔,受限平均生存时间,考克斯模型) 的趋势分析.
- 对LDD和非LDD接受者之间的结果进行比较,考虑到捐赠者距离和寒冷缺血时间.
主要成果:
- 2018年政策变化后,LDD利用率显著增加,平均捐赠者距离从171英里增加到288英里.
- 与非LDD接受者相比,LDD接受者在30天,1年和5年的随访中风险调整后的存活率明显更好.
- 在匹配的队列中,观察到捐赠者距离和缺血时间之间的弱相关性,这表明距离不是缺血的直接替代品.
结论:
- 2018年的政策变化导致了心脏移植中LDD的使用大幅增加.
- 较长的供体距离并不等同于较长的缺血时间,LDD的使用与改善的生存结果有关.
- 需要进一步的研究,以充分阐明LDD在HT中的好处和影响.
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