Impact of Heart Failure Etiology on Waitlist Mortality in Heart Transplant Candidates Supported With Extracorporeal Membrane Oxygenation

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-08-14 DOI:10.1111/ctr.15421

Manuj M. Shah, Emily Rodriguez, Benjamin L. Shou, Reed T. Jenkins, Hannah Rando, Ahmet Kilic

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Abstract

Background

Extracorporeal membrane oxygenation (ECMO) has gained traction as a bridge to heart transplantation (HT) but remains associated with increased waitlist mortality. This study explores whether this risk is modified by underlying heart failure (HF) etiology.

Methods

Using the Organ Procurement and Transplantation Network registry, we conducted a retrospective review of first-time adult HT candidates from 2018 through 2022. Patients were categorized as “ECMO”, if ECMO was utilized during the waitlisting period, or “No ECMO” otherwise. Patients were then stratified according to the following HF etiology: ischemic cardiomyopathy (CMP), dilated nonischemic CMP, restrictive CMP, hypertrophic CMP, and congenital heart disease (CHD). After baseline comparisons, waitlist mortality was characterized for ECMO and HF etiology using the Fine–Gray regression.

Results

A total of 16 143 patients were identified of whom 7.0% (n = 1063) were bridged with ECMO. Compared to No ECMO patients, ECMO patients had shorter waitlist durations (46.3 vs. 185.0 days, p < 0.01) and were more likely to undergo transplantation (75.3% vs. 70.3%, p < 0.01). Outcomes analysis revealed that ECMO was associated with increased mortality risk (subdistribution hazard ratio [SHR]: 3.42, p < 0.01), a risk that persisted in all subgroups and was notably high in CHD (SHR: 4.83, p < 0.01) and hypertrophic CMP (SHR: 9.78, p < 0.01). HF etiology comparison within ECMO patients revealed increased mortality risk with CHD (SHR: 3.22, p < 0.01). Within No ECMO patients, hypertrophic CMP patients had lower mortality risk (SHR: 0.64, p = 0.03).

Conclusions

The increased waitlist mortality risk with ECMO persisted after stratification by HF etiology. These findings can help decision-making surrounding candidacy for cannulation and prognostic evaluation.

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心力衰竭病因对体外膜氧合心脏移植候选者候诊死亡率的影响

背景：体外膜肺氧合(ECMO)作为心脏移植(HT)的桥梁已受到越来越多的关注，但仍与等待者死亡率的增加有关。本研究探讨了这种风险是否会因潜在的心力衰竭（HF）病因而改变：我们利用器官获取和移植网络登记处，对 2018 年至 2022 年首次接受心脏移植的成人候选者进行了回顾性研究。如果患者在候选期间使用了 ECMO，则将其归类为 "ECMO"，否则归类为 "无 ECMO"。然后根据以下高频病因对患者进行分层：缺血性心肌病 (CMP)、扩张型非缺血性心肌病 (CMP)、限制型心肌病 (CMP)、肥厚型心肌病 (CMP) 和先天性心脏病 (CHD)。经过基线比较后，使用 Fine-Gray 回归法对 ECMO 和 HF 病因的候补名单死亡率进行了分析：结果：共确定了 16 143 名患者，其中 7.0%（n = 1063）的患者接受了 ECMO 桥接。与未使用 ECMO 的患者相比，ECMO 患者的候诊时间更短（46.3 天对 185.0 天，P 结论：ECMO 患者的候诊时间更短，而 ECMO 患者的候诊时间更长：根据心房颤动病因分层后，ECMO 增加的候诊死亡率风险依然存在。这些发现有助于围绕插管候选资格和预后评估做出决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.