在2018年美国心脏分配变化后,状态1例外实践和候选结果的变化
Nikhil Narang1, Thomas M Cascino2, Jennifer A Cowger3
1Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL.
Journal of cardiac failure
|February 4, 2026
概括
自2018年以来,心脏移植状态1列表的数量翻了一番,主要是由于异常 (1E) 使用的增加. 虽然1E候选人面临着类似的移植率,但那些像O血型这样的缺点的人仍然面临高风险.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 状态1列表意味着心脏移植 (HT) 的最高优先级,保留给急症候选人,例如需要VA-ECMO的候选人.
- 2018年分配系统的变化旨在优化器官分配并改善心脏移植候选人的结果.
研究的目的:
- 分析2018年后的状态1心脏移植名单的纵向趋势.
- 评估中心级列表实践的变化,特别是例外的使用.
- 评估分配变化对移植结果的影响,比较列出的候选人有和没有例外.
主要方法:
- 从器官采购和移植网络 (OPTN) 分析了在2018年10月至2024年7月期间被列为状态1的成人,首次,单器官HT候选人的非识别数据.
- 根据时间,地理区域和移植中心规模对整体和例外 (1E) 列表的趋势的评估.
- 应用细灰分区危险回归来比较30天移植和删除率的死亡/恶化基于例外状态.
主要成果:
- 在2018年至2024年期间,状态1列表从7.1%增加到14.4%,主要是由于1E列表的增加 (2.3%至9.8%),到2024年,该列表占状态1列表的50%以上.
- 在不同移植中心和地区观察到使用1E列表的显著差异.
- 列为1E的候选人表现出类似的30天移植率,但与非例外的状态1候选人相比,由于死亡或恶化而被删除的风险较低.
结论:
- 在2018年之后,使用状态1心脏移植清单的数量显著增加,例外 (1E) 标准的应用显著增加,显示出相当大的中心间变化.
- 与传统的状态1患者相比,在1E状态下列出的候选人似乎在移植前的病情不那么严重.
- 患有特定缺点的患者,如血型O或高面板反应性抗体 (PRA≥30%),继续面临不良结果的高风险,包括心脏移植率降低和因死亡/恶化而增加的退出名单.
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