دورية أكاديمية
أعرض في EDS

Prolonged Ischemia Increases Complications Among High- and Low-Volume Centers in Lung Transplantation.

التفاصيل البيبلوغرافية
العنوان: Prolonged Ischemia Increases Complications Among High- and Low-Volume Centers in Lung Transplantation.
المؤلفون: Wadowski BJ; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York. Electronic address: benjamin.wadowski@med.nyu.edu., Wang S; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York., Angel LF; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York., Geraci TC; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York., Chan JCY; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York., Chang SH; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
المصدر: The Annals of thoracic surgery [Ann Thorac Surg] 2023 Aug; Vol. 116 (2), pp. 374-381. Date of Electronic Publication: 2022 Oct 28.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 15030100R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6259 (Electronic) Linking ISSN: 00034975 NLM ISO Abbreviation: Ann Thorac Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: Amsterdam : Elsevier
Original Publication: Boston.
مواضيع طبية MeSH: Lung Transplantation*, Humans ; Postoperative Complications ; Benchmarking ; Databases, Factual ; Ischemia
مستخلص: Background: The effect of prolonged allograft ischemic time on lung transplant outcomes remains controversial, with most studies associating it with increased mortality, but this effect is partly mitigated by center volume. This study sought to evaluate the mechanism of these findings and clarify the impact of ischemic time on short-term outcomes in a national sample.
Methods: Data on lung transplants (January 2010-Janary 2017) were extracted from the Scientific Registry of Transplant Recipients database. Ischemic time was dichotomized as prolonged ischemic time (PIT) or no PIT (N-PIT) at 6 hours. High-volume centers were defined as the top quintile. The primary outcome was 30-day, 1-year, and 3-year mortality; secondary outcomes included in-hospital complications and 72-hour oxygenation.
Results: Among 11,809 records, there were significant differences between PIT and N-PIT recipients by demographics, lung allocation score, and donor organ metrics. In a 1:1 propensity score-matched cohort (n = 6422), PIT recipients had reduced survival compared with N-PIT at 3 years (66.5% vs 68.8%, P = .031). On multivariable analysis, this effect persisted among low-volume but not high-volume centers. PIT recipients were more likely to require reintubation, prolonged (>5 days) mechanical ventilation, hemodialysis, longer stay, and acute rejection (all P < .01). Except for reintubation, these disparities were present at both high- and low-volume centers independently. Ischemic time had no effect on 72-hour oxygenation.
Conclusions: PIT remains associated with higher rates of postoperative complications and reduced short-term survival. While center volume ameliorated the survival impact, this was not achieved by reducing postoperative complications. Further research is warranted before broadening ischemic time thresholds among low-volume centers.
(Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
التعليقات: Comment in: Ann Thorac Surg. 2023 Aug;116(2):382. (PMID: 36521522)
تواريخ الأحداث: Date Created: 20230725 Date Completed: 20230726 Latest Revision: 20230726
رمز التحديث: 20230726
DOI: 10.1016/j.athoracsur.2022.10.018
PMID: 37489398
قاعدة البيانات: MEDLINE
الوصف
تدمد:1552-6259
DOI:10.1016/j.athoracsur.2022.10.018