Arnaud Roussel, Edouard Sage, Pierre-Emmanuel Falcoz, Pascal Alexandre Thomas, Yves Castier, Elie Fadel, Françoise Le Pimpec-Barthes, François Tronc, Jacques Jougon, Philippe Lacoste, Johanna Claustre, Laurent Brouchet, Richard Dorent, Edward Cantu, Michael Harhay, Raphaël Porcher, Pierre Mordant
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引用次数: 0
Abstract
Introduction: Lung graft allocation can be based on a score (Lung Allocation Score) as in the USA or sequential proposals combined with a discrete priority model as in France. We aimed to analyse the impact of allocation policy on the outcome of urgent lung transplantation (LT).
Methods: US United Network for Organ Sharing (UNOS) and French Cristal databases were retrospectively reviewed to analyse LT performed between 2007 and 2017. We analysed the mortality risk of urgent LT by fitting Cox models and adjusted Restricted Mean Survival Time. We then compared the outcome after urgent LT in the UNOS and Cristal groups using a propensity score matching.
Results: After exclusion of patients with chronic obstructive pulmonary disease/emphysema and redo LT, 3775 and 12 561 patients underwent urgent LT and non-urgent LT in the USA while 600 and 2071 patients underwent urgent LT and non-urgent LT in France. In univariate analysis, urgent LT was associated with an HR for death of 1.24 (95% CI 1.05 to 1.48) in the Cristal group and 1.12 (95% CI 1.05 to 1.19) in the UNOS group. In multivariate analysis, the effect of urgent LT was attenuated and no longer statistically significant in the Cristal database (HR 1.1 (95% CI 0.91 to 1.33)) while it remained constant and statistically significant in the UNOS database (HR 1.12 (95% CI 1.05 to 1.2)). Survival comparison of urgent LT patients between the two countries was significantly different in favour of the UNOS group (1-year survival rates 84.1% (80.9%-87.3%) vs 75.4% (71.8%-79.1%) and 3-year survival rates 66.3% (61.9%-71.1%) vs 62.7% (58.5%-67.1%), respectively).
Conclusion: Urgent LT is associated with adverse outcome in the USA and in France with a better prognosis in the US score-based system taking post-transplant survival into account. This difference between two healthcare systems is multifactorial.
导言:肺移植的分配可以像美国那样基于评分(肺分配评分),也可以像法国那样基于顺序建议结合离散优先模式。我们旨在分析分配政策对紧急肺移植(LT)结果的影响:我们对美国器官共享联合网络(UNOS)和法国Cristal数据库进行了回顾性审查,分析了2007年至2017年间进行的肺移植手术。我们通过拟合Cox模型和调整后的限制平均生存时间分析了紧急LT的死亡风险。然后,我们采用倾向得分匹配法比较了UNOS组和Cristal组紧急LT术后的结果:在排除慢性阻塞性肺病/肺气肿和重做LT的患者后,美国分别有3775名和12561名患者接受了紧急LT和非紧急LT治疗,而法国分别有600名和2071名患者接受了紧急LT和非紧急LT治疗。在单变量分析中,紧急LT与Cristal组死亡HR的相关性为1.24(95% CI 1.05至1.48),与UNOS组死亡HR的相关性为1.12(95% CI 1.05至1.19)。在多变量分析中,紧急LT的影响在Cristal数据库中有所减弱,不再具有统计学意义(HR 1.1 (95% CI 0.91 to 1.33)),而在UNOS数据库中则保持不变,具有统计学意义(HR 1.12 (95% CI 1.05 to 1.2))。两国急诊LT患者的存活率比较结果显示,UNOS组患者的存活率明显高于急诊LT组(1年存活率分别为84.1%(80.9%-87.3%)vs 75.4%(71.8%-79.1%),3年存活率分别为66.3%(61.9%-71.1%)vs 62.7%(58.5%-67.1%)):结论:在美国和法国,急诊LT与不良预后有关,而在美国基于评分的系统中,考虑到移植后存活率,LT的预后更好。两种医疗体系之间的这种差异是多因素造成的。
期刊介绍:
Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.