■将已故器官捐献者管理和器官恢复集中到捐献者护理单位(DCU)可以通过积极影响捐赠和接受者的结果来减轻严重的器官短缺。
■比较两种常见DCU模型之间的捐赠和肺移植结果:独立(急性护理医院以外)和以医院为基础。
■这是一项回顾性队列研究,研究了来自21个美国供体服务区的器官获取和移植网络死者供者登记和肺移植受者档案。比较了在独立和基于医院的DCU中照顾的已故捐献者的特征和肺捐赠率。符合条件的参与者包括脑死亡后死亡的器官捐献者(16岁及以上),在2017年4月26日至2022年6月30日期间接受了器官恢复手术的患者,以及从这些供体接受肺移植的患者。数据分析于2023年5月至2024年3月进行。
■在独立DCU中恢复器官(与基于医院的DCU相比)。
■主要结果是从队列供体移植的肺受者的移植肺存活时间(至2023年12月31日)。按移植年份和程序分层的Cox比例风险模型,根据供体和受体特征进行校正,以比较移植物存活率.
■起始样本中的10856个供体(平均[SD]年龄,42.8[15.2]岁;6625名男性[61.0%]和4231名女性[39.0%]),5149(主要对照组)在DCU中接受了恢复程序,包括11个医院DCU中的1466(28.4%)和10个独立DCU中的3683(71.5%)。DCU中未经调整的肺捐献率高于当地医院,但在以医院为基础的DCU与独立DCU中更低(418个捐献者[28.5%]vs1233个捐献者[33.5%];P<.001)。在1657名移植接受者中,1250(74.5%)接受来自独立DCU的肺。移植后随访的中位(范围)持续时间为734(0-2292)天。从独立DCU中恢复的移植物比从医院DCU中恢复的移植物具有更短的限制性平均(SE)生存时间(1548[27]天比1665[50]天;P=.04)。调整后,从独立DCU恢复的肺中的移植物衰竭仍然高于基于医院的DCU(风险比,1.85;95%CI,1.28-2.65)。
■在对国家供体和移植受体数据的回顾性分析中,尽管在独立DCU中照顾脑死亡后,已故器官捐献者的肺捐赠率更高,从基于医院的DCU的供体中恢复的肺存活时间更长。这些发现表明,需要进一步的工作来了解哪些因素(例如,捐赠者转移,管理,或肺部评估和接受实践)在DCU模型之间存在差异,并且可能导致这些差异。
UNASSIGNED: Centralizing deceased organ donor management and organ recovery into donor care units (DCUs) may mitigate the critical organ shortage by positively impacting donation and recipient outcomes.
UNASSIGNED: To compare donation and lung transplant outcomes between 2 common DCU models: independent (outside of acute-care hospitals) and hospital-based.
UNASSIGNED: This is a retrospective cohort study of Organ Procurement and Transplantation Network deceased donor registry and lung transplant recipient files from 21 US donor service areas with an operating DCU. Characteristics and lung donation rates among deceased donors cared for in independent vs hospital-based DCUs were compared. Eligible participants included deceased organ donors (aged 16 years and older) after brain death, who underwent organ recovery procedures between April 26, 2017, and June 30, 2022, and patients who received lung transplants from those donors. Data analysis was conducted from May 2023 to March 2024.
UNASSIGNED: Organ recovery in an independent DCU (vs hospital-based DCU).
UNASSIGNED: The primary outcome was duration of transplanted lung survival (through December 31, 2023) among recipients of lung(s) transplanted from cohort donors. A Cox proportional hazards model stratified by transplant year and program, adjusting for donor and recipient characteristics was used to compare graft survival.
UNASSIGNED: Of 10 856 donors in the starting sample (mean [SD] age, 42.8 [15.2] years; 6625 male [61.0%] and 4231 female [39.0%]), 5149 (primary comparison group) underwent recovery procedures in DCUs including 1466 (28.4%) in 11 hospital-based DCUs and 3683 (71.5%) in 10 independent DCUs. Unadjusted lung donation rates were higher in DCUs than local hospitals, but lower in hospital-based vs independent DCUs (418 donors [28.5%] vs 1233 donors [33.5%]; P < .001). Among 1657 transplant recipients, 1250 (74.5%) received lung(s) from independent DCUs. Median (range) duration of follow-up after transplant was 734 (0-2292) days. Grafts recovered from independent DCUs had shorter restricted mean (SE) survival times than grafts from hospital-based DCUs (1548 [27] days vs 1665 [50] days; P = .04). After adjustment, graft failure remained higher among lungs recovered from independent DCUs than hospital-based DCUs (hazard ratio, 1.85; 95% CI, 1.28-2.65).
UNASSIGNED: In this retrospective analysis of national donor and transplant recipient data, although lung donation rates were higher from deceased organ donors after brain death cared for in independent DCUs, lungs recovered from donors in hospital-based DCUs survived longer. These findings suggest that further work is necessary to understand which factors (eg, donor transfer, management, or lung evaluation and acceptance practices) differ between DCU models and may contribute to these differences.