Procurement Trends, Indications, and Outcomes of Heart-Lung Transplantation in the Contemporary Era.

Autor: Treffalls JA; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Bilgili A; College of Medicine, University of Florida, Gainesville, Florida, USA., Brennan Z; Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA., Sharaf OM; College of Medicine, University of Florida, Gainesville, Florida, USA., Griffeth EM; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Chen Q; Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA., Pennington K; Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Spencer PJ; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA., Villavicencio MA; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Daly RC; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA., Saddoughi SA; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.; Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Sep; Vol. 38 (9), pp. e15447.
DOI: 10.1111/ctr.15447
Abstrakt: Background: Evolving trends in organ procurement and technological innovation prompted an investigation into recent trends, indications, and outcomes following combined heart-lung transplantation (HLTx).
Methods: The United Network for Organ Sharing database was queried for all adult (≥18 years) HLTx performed between July 1, 2013 and June 30, 2023. Patients with previous transplants were excluded. The primary endpoint was the effect of donor, recipient, and transplantation characteristics on 1- and 5-year survival. Secondary analyses included a comparison of HLTx at high- and low-volume centers, an assessment of HLTx following donation after circulatory death (DCD), and an evaluation of HLTx volume over time. Cox proportional-hazards models were used to assess factors associated with mortality. Temporal trends were evaluated with linear regression.
Results: After exclusions, 319 patients were analyzed, of whom 5 (1.6%) were DCD. HLTx volume increased from 2013 to 2023 (p < 0.001). One- and 5-year survival following HLTx was 84.0% and 59.5%, respectively. One-year survival was higher for patients undergoing HLTx at a high-volume center (88.3% vs. 77.9%; p = 0.012). After risk adjustment, extracorporeal membrane oxygenation support 72 h posttransplant and predischarge dialysis were associated with increased 1-year mortality (HR = 3.19, 95% CI = 1.86-5.49 and HR = 3.47, 95% CI = 2.17-5.54, respectively) and 5-year mortality (HR = 2.901, 95% CI = 1.679-5.011 and HR = 3.327, 95% CI = 2.085-5.311, respectively), but HLTx at a high-volume center was not associated with either.
Conclusions: HLTx volume has resurged, with DCD HLTx emerging as a viable procurement strategy. Factors associated with 1- and 5-year survival may be used to guide postoperative management following HLTx.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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