在最初接受移植后,手术期间捐赠者心脏倒闭的预测因素
Armaan F Akbar1, Alice L Zhou1, Jessica M Ruck1
1Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md.
JTCVS open
|December 31, 2025
概括
接受捐赠心脏的手术内转移正在增加,在循环死亡后的捐赠和较老的捐赠者年龄是关键的风险因素. 识别这些因素可以帮助保存供体心脏进行移植.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 公共卫生 公共卫生
背景情况:
- 由于使用率较低,最大限度地利用心脏捐赠者至关重要.
- 尽量减少被接受的心脏供应的丢弃是移植的优先事项.
研究的目的:
- 为了研究最初接受移植的捐赠心脏的手术内转移 (ITD) 的风险因素.
- 分析国家注册数据,以了解心脏移植在手术期间丢弃的预测因素.
主要方法:
- 分析2005年1月至2023年3月的成年已故捐赠者的数据,使用美国器官共享网络数据库.
- 基于心脏全移植使用与手术内转移的基础上对捐赠者的分类.
- 多变量逻辑回归用于识别ITD的风险因素,调整为共变量.
主要成果:
- 在48,240名接受的潜在心脏捐赠者中,有90.0%被使用,2.6%经历了ITD,7.4%没有因为其他原因而被使用.
- 在手术期间的倒闭率从2005年的0.75%增加到2023年的2.2%.
- 循环死亡后的捐赠 (aOR,2.60) 和较老的捐赠者年龄 (≥50岁,aOR,2.02) 是ITD最强的独立风险因素.
结论:
- 几种因素与手术内转移有关,包括循环死亡后的捐赠,较老的捐赠者年龄,减少射出分数和高血压.
- 识别这些风险因素可以指导预期的手术内评估,并改善团队协调.
- 这些发现旨在保持对移植供体心脏的获取.
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