Implications of declining donor offers with increased risk of disease transmission on waiting list survival in lung transplantation

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:38

Article

Cox, Morgan L.¹  Mulvihill, Michael S.¹  Choi, Ashley Y.²  Bishawi, Muath¹  Osho, Asishana A.³  Haney, John C.¹  Daneshmand, Mani¹  Klapper, Jacob A.¹  Wolfe, Cameron R.⁴  Hartwig, Matthew¹ 

[1] Duke Univ, Div Cardiovasc & Thorac Surg, Durham, NC USA

[2] Duke Univ, Sch Med, Durham, NC USA

[3] Massachusetts Gen Hosp, Dept Surg, Boston, MA 02114 USA

[4] Duke Univ, Div Infect Dis, Durham, NC USA

关键词: lung transplant;    increased-risk donor;    organ allocation;    waiting list survival;    post-transplant survival;   

DOI  :  10.1016/j.healun.2018.12.012

来源: Elsevier

【 摘 要 】

BACKGROUND: Donors with characteristics that may increase the likelihood of disease transmission with transplantation are noted as increased risk via Public Health Service criteria. This study aimed to establish the implications of declining an increased-risk donor (IRD) organ offer in lung transplantation. METHODS: Adult candidates waitlisted for isolated lung transplantation in the United States using the Organ Procurement and Transplantation Network / United Network of Organ Sharing registry from 2007 to 2017 were identified. Individual match run files identified candidate recipients who matched to an IRD offer. Competing-risks analysis ascertained the likelihood of survival to transplantation. A stratified Cox model and restricted mean survival times estimated the survival benefit associated with the acceptance of an IRD organ. RESULTS: A total of 6,963 candidates met inclusion criteria, and 1,473 (21.2%) accepted an IRD offer. Candidates who accepted an IRD offer were older, more likely to be male, and had a higher lung allocation score at the time of listing (all p < 0.05). At 1 year after an IRD offer decline, 70.5% of candidates underwent a lung transplant, 13.8% died or decompensated, and 14.9% were still awaiting transplant. Compared with those who declined, candidates who accepted the IRD offer had significantly improved cumulative mortality at 1 year (14.1% vs 23.9%, p < 0.001) and 5 years (48.4% vs 53.8%, p < 0.001). CONCLUSIONS: IRD organ declination is associated with a decreased rate of lung transplantation and worse survival. Overall post-transplant survival rates for those who survive to transplantation are equivalent. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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