Bridge to simultaneous heart-kidney transplantation via extracorporeal life support: National outcomes in the new heart allocation policy era.

Autor:	Feng I; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Kurlansky PA; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York; Center of Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, New York., Zhao Y; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Patel K; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Moroi MK; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Vinogradsky AV; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Latif F; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Sayer G; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Uriel N; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Naka Y; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Takeda K; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York. Electronic address: kt2485@cumc.columbia.edu.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2025 Jan; Vol. 44 (1), pp. 11-21. Date of Electronic Publication: 2024 Sep 06.
DOI:	10.1016/j.healun.2024.08.020
Abstrakt:	Background: Since United Network for Organ Sharing (UNOS) revised their heart allocation policy in 2018, usage of veno-arterial extracorporeal life support (VA-ECLS) has dramatically increased as a bridge to transplant. This study investigated outcomes of VA-ECLS patients bridged to simultaneous heart-kidney transplant (SHK) in the new policy era. Methods: This study included 774 adult patients from the UNOS database who received SHK between 10/18/18 and 12/31/21 and compared patients bridged to transplant on VA-ECLS (n = 50) with those not bridged (n = 724). Results: At baseline, SHK recipients bridged from VA-ECLS were younger (50.5 vs 58.0 years, p = 0.007), had higher estimated glomerular filtration rate (eGFR) at time of transplant (47.6 vs 30.1, p < 0.001), and spent fewer days on the waitlist (7.0 vs 33.5 days, p < 0.001). In the perioperative period, VA-ECLS was associated with higher rates of temporary dialysis (56.0% vs 28.0%, p < 0.001) but similar 2-year cumulative incidence of chronic dialysis (7.5% vs 5.4%, p = 0.800) and renal allograft failure (12.0% vs 8.1%, p = 0.500) compared to non-ECLS cohort. However, VA-ECLS patients had decreased survival to discharge (76.0% vs 92.7%, p < 0.001) and 2-year post-transplant survival (71.7% vs 83.0%, p = 0.004), as well as greater 2-year cumulative incidence of cardiac allograft failure (10.0% vs 2.7%, p = 0.002). Multivariable analyses found VA-ECLS at time of transplant to be independently associated with 2-year post-transplant mortality (HR [95% CI]: 3.40 [1.66-6.96], p = 0.001) and cardiac allograft failure (sub-distribution hazard ratio [SHR] [95% CI]: 8.51 [2.77-26.09], p < 0.001). Conclusion: Under the new allocation policy, patients bridged to SHK from VA-ECLS displayed greater early mortality and cardiac allograft failure but similar renal outcomes compared to non-ECLS counterparts. (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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