دورية أكاديمية
Use of extended criteria donor hearts in combined heart-kidney transplant confers greater risk of mortality.
| العنوان: | Use of extended criteria donor hearts in combined heart-kidney transplant confers greater risk of mortality. |
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| المؤلفون: | Shin M; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Iyengar A; Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Helmers MR; Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Patrick WL; Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Cohen W; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Weingarten N; Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Rekhtman D; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Song C; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Atluri P; Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Cevasco M; Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Marisa.cevasco@pennmedicine.upenn.edu. |
| المصدر: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2023 Jul; Vol. 42 (7), pp. 943-952. Date of Electronic Publication: 2023 Feb 19. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 9102703 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-3117 (Electronic) Linking ISSN: 10532498 NLM ISO Abbreviation: J Heart Lung Transplant Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 1999- : New York, NY : Elsevier Original Publication: St. Louis, Mo. : Mosby-Year Book, Inc., c1991- |
| مواضيع طبية MeSH: | Kidney Transplantation* , Heart Transplantation*, Adult ; Humans ; Tissue Donors ; Treatment Outcome ; Retrospective Studies ; Graft Survival ; Kidney |
| مستخلص: | Background: Extended criteria donors (ECD) hearts have demonstrated acceptable outcomes in select populations. However, their use in patients undergoing simultaneous heart-kidney transplantation (SHKT) has not been explored. This study is assessed the effect of ECD hearts in patients undergoing SHKT vs isolated heart transplants (IHT). Methods: The United Network for Organ Sharing (UNOS) database was queried for all adult patients undergoing IHT and SHKT. Patients were stratified by receipt of ECD heart, defined as donor hearts failing to meet established acceptable use criteria. Interaction effects between ECDs and simultaneous kidney transplants were generated. Postoperative outcomes, risk factors, and patient/graft survival were compared across cohorts using Fine-Gray, Kaplan Meier, and Cox Proportional Hazards analyses. Results: Among 26,207 patients included, 1,766 (7%) underwent SHKT. ECD hearts were used in 25% of both IHT and SHKT cohorts. Five-year survival among SHKT/ECD patients (67.3%) was reduced (p < 0.01) compared to SHKT/SDC (80.3%), IHT/ECD (78.1%) and IHT/SCD (80.0%) groups. Among SHKT patients, use of ECD hearts was associated with increased risk (SHR: 1.48; p < 0.01) of renal graft failure compared to SCD hearts. Among SHKT patients, receipt of an ECD heart, and individual ECD criteria (coronary disease and size mismatch >20%), predicted mortality. The interaction effect of receiving both ECD and SHKT predicted mortality and graft failure (HR 1.43; p < 0.01). Conclusions: Patients undergoing SHKT with an ECD heart face greater risks of mortality and graft failure in comparison to those undergoing IHT with ECD hearts. Careful selection of donor organs should be applied to this high-risk cohort. (Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: extended criteria donors; heart transplantation; heart-Kidney transplantation; kidney transplantation; marginal donors |
| تواريخ الأحداث: | Date Created: 20230314 Date Completed: 20230619 Latest Revision: 20240102 |
| رمز التحديث: | 20240102 |
| DOI: | 10.1016/j.healun.2023.02.004 |
| PMID: | 36918338 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1557-3117 |
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| DOI: | 10.1016/j.healun.2023.02.004 |