Survival trends in heart transplant patients supported on ECMO and IABP: A 10-year UNOS database analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS IJC Heart and Vasculature Pub Date : 2024-08-13 DOI:10.1016/j.ijcha.2024.101486
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Abstract

The United Network for Organ Sharing (UNOS) heart transplant allocation policy was changed in 2018. This study examines the impact of the change in UNOS heart transplant allocation policy on the use of temporary mechanical circulatory support (MCS) devices and post-transplant survival.

The analysis included a total of 26,481 patients listed and transplanted between January 2013 and June 2022. The results showed a decrease in waiting time for transplant after the policy change, indicating a successful reduction in waitlist time for high-priority status patients. However, the length of hospital stays from transplant to discharge increased following the policy change. The study also found an increase in the frequency of ECMO and IABP use both at the time of listing and at the time of transplant following the policy change.

Cumulative patient and graft survival at 1000 days decreased following the policy change (86.1 per cent versus 83.7 per cent at 1000 days, p = 0.002). However, the survival curves showed similar survival trends in the first 2 years, with late divergence in survival occurring after 2 years.

In conclusion the latest UNOS heart transplant allocation policy change led to a decrease in waiting times and an increase in the use of temporary MCS devices. There was a decrease in cummulative survival at 1000 days following the policy change.

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使用 ECMO 和 IABP 支持的心脏移植患者的生存趋势:联合国手术室十年期数据库分析
器官共享联合网络(UNOS)的心脏移植分配政策在2018年发生了变化。本研究探讨了UNOS心脏移植分配政策的改变对临时机械循环支持(MCS)装置的使用和移植后存活率的影响。分析对象包括2013年1月至2022年6月期间列入名单并接受移植的26481名患者。结果显示,政策改变后等待移植的时间缩短了,这表明高优先级患者的等待时间成功缩短了。然而,政策改变后,从移植到出院的住院时间增加了。研究还发现,在政策改变后,患者列名时和移植时使用 ECMO 和 IABP 的频率都有所增加。政策改变后,1000 天的患者和移植物累积存活率下降(1000 天为 86.1% 对 83.7%,P = 0.002)。总之,UNOS 心脏移植分配政策的最新变化缩短了等待时间,增加了临时 MCS 装置的使用。政策改变后,1000 天的累积存活率有所下降。
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来源期刊
IJC Heart and Vasculature
IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
10.30%
发文量
216
审稿时长
56 days
期刊介绍: IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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