Variability in donor organ offer acceptance and lung transplantation survival.

Autor:	Mulvihill MS; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina. Electronic address: mike.mulvihill@duke.edu., Lee HJ; Surgical Center for Outcomes Research, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina., Weber J; Duke Clinical Research Institute, Durham, North Carolina., Choi AY; Duke University School of Medicine, Durham, North Carolina., Cox ML; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Yerokun BA; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Bishawi MA; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina., Klapper J; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina., Kuchibhatla M; Surgical Center for Outcomes Research, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina., Hartwig MG; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2020 Apr; Vol. 39 (4), pp. 353-362. Date of Electronic Publication: 2020 Jan 21.
DOI:	10.1016/j.healun.2019.12.010
Abstrakt:	Background: Lung transplantation offers a survival benefit for patients with end-stage lung disease. When suitable donors are identified, centers must accept or decline the offer for a matched candidate on their waitlist. The degree to which variability in per-center offer acceptance practices impacts candidate survival is not established. The purpose of this study was to determine the degree of variability in per-center rates of lung transplantation offer acceptance and to ascertain the associated contribution to observed differences in per-center waitlist mortality. Methods: We performed a retrospective cohort study of candidates waitlisted for lung transplantation in the US using registry data. Logistic regression was fit to assess the relationship of offer acceptance with donor, candidate, and geographic factors. Listing center was evaluated as a fixed effect to determine the adjusted per-center acceptance rate. Competing risks analysis employing the Fine-Gray model was undertaken to establish the relationship between adjusted per-center acceptance and waitlist mortality. Results: Of 15,847 unique organ offers, 4,735 (29.9%) were accepted for first-ranked candidates. After adjustment for important covariates, transplant centers varied markedly in acceptance rate (9%-67%). Higher cumulative incidence of 1-year waitlist mortality was associated with lower acceptance rate. For every 10% increase in adjusted center acceptance rate, the risk of waitlist mortality decreased by 36.3% (sub-distribution hazard ratio 0.637; 95% confidence interval 0.592-0.685). Conclusions: Variability in center-level behavior represents a modifiable risk factor for waitlist mortality in lung transplantation. Further intervention is needed to standardize center-level offer acceptance practices and minimize waitlist mortality. (Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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