周一“星”视角|使用新型供体肺评分系统作为提高移植肺恢复率的工具；移植时间对肺移植术后结果的影响（夜间肺移植）

01

Yun Zhu Bai1, MD, Yan Yan, MD, PhD2, Su-Hsin Chang, PhD, SM2, Zhizhou Yang, MD1,3, Anjana Delhi, MBBS, MPH1, Khashayar Farahnak, MD1, Karan Joseph, BS4, Christy Hamilton1, Ana Amelia Baumann Walker, PhD2, Ramsey R. Hachem, MD5, Chad A. Witt, MD5, Rodrigo Vazquez Guillamet, MD5, Derek E. Byers, MD, PhD5, Gary F. Marklin, MD6, Matthew G. Hartwig, MD7, Whitney S. Brandt, MD1, Daniel Kreisel, MD, PhD1, Ruben G. Nava, MD1, G. Alexander Patterson1, MD, Benjamin D. Kozower, MD, MPH1, Bryan F. Meyers, MD, MPH1,  Brendan T. Heiden, MD, MPHS1, Varun Puri, MD, MSCI1

1 Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: y.bai@wustl.edu.

2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO.

3 Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; Department of Surgery, Massachusetts General Hospital, Boston, MA.

4 Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.

5 Washington University School of Medicine, St. Louis, MO.

6 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO.

7 Mid-America Transplant, St. Louis, MO.

8 Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Objective: 

There is a critical shortage of donor lungs for transplantation. We previously developed a parsimonious, highly discriminatory nine-variable Lung Donor (LUNDON) acceptability score. We assess the utility of this score as a tool to improve lung recovery rates for transplantation.

Methods: 

We examined all brain-dead donors between 2014-2020 from three US organ procurement organizations and validated the score’s predictive performance. We examined the trajectory of donors with low (<40) and high (>60) initial LUNDON scores, their corresponding lung recovery rates, factors contributing to score improvement using multivariable regression models, and one-year post-transplant recipient survival.

Results: 

Overall lung recovery was 32.4% (1410/4351). Validation of the LUNDON score in our cohort revealed a C statistic of 0.904 but required intercept calibration. Low initial LUNDON donors that improved to a high final score had an increase in lung recovery rate from 29.3%  (1100/3765) to 86.8% (441/508), associated with lower BMI, management in specialized donor care facilities (SDCF), and more bronchoscopies. Donors with high initial and final LUNDON scores had lung recovery rate of 85.2% (98/115), associated with shor lengths of stay. One- year survival was similar between recipients of low-to-high versus high-to-high LUNDON score donors (0.89 vs 0.84, P=0.2).

Conclusion: The LUNDON score performs well as a predictor of lung recovery in a contemporary cohort but may require OPO-specific calibration. SDCF use, more bronchoscopies, and expediting time from brain death to organ procurement may improve lung utilization. The LUNDON score can be used to guide donor management to expand the donor pool.  

[CITATION]: Patterson GA, Kozower BD, Meyers BF, et al. Use of a novel donor lung scoring system as a tool for increasing lung recovery for transplantation. J Thorac Cardiovasc Surg. 2024 Sep 1:S0022-5223(24)00781-5. 

[DOI]: 10.1016/j.jtcvs.2024.08.047. 

[IF]: 4.9

02

Kukbin Choi1, Salah E Altarabsheh2, Sahar A Saddoughi2, Philip J Spencer2, Brian Lahr3, Defne G Ergi2, Erin Schumer4, Mauricio A Villavicencio2

1 Division of Cardiac Surgery, Ohio State University, Columbus, Ohio.

2 Department of Cardiovascular surgery, Mayo Clinic, Rochester, Minnesota.

3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.

4 Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.

Background: 

Surgical outcomes have been linked to the technical and cognitive abilities of an exhausted surgical team. In parallel, advancements in preservation have led to the proposal of daytime lung transplants. We sought to investigate whether time of day is associated with outcomes in lung transplants.

Methods: 

Data on 30,404 lung transplants from 2005 to 2021 were obtained from the United Network for Organ Sharing database. Patients were categorized based on the time of surgery with "early-hours" defined as donor cross-clamp between 10PM and 3AM, and Cox regression models for 90-day and long-term mortality were made to assess the risk according to time of transplant and covariates. Additionally, the Cox modeling was repeated with donor cross-clamp and the estimated reperfusion time of day as continuous functions.

Results: 

Among 30,404 transplants, 20.7% (6,295) were performed during "early-hours". No significant difference was found between the two groups in unadjusted 90-day and long-term mortality (log-rank, P = 0.176 and 0.363), and results were unchanged when adjusting for covariates (P = 0.233 and 0.738). However, when examining donor cross-clamp time and reperfusion time as continuous variables in separate multivariable analyses, we observed significant associations with 90-day mortality (P = 0.002 and 0.022). Notably, lower mortality rates were observed for donor clamp-times between 8AM to 1PM and estimated reperfusion times between 1PM to 6PM.

Conclusions: 

Although binary categorizations of the time of day of lung transplants did not show a significant impact on short- or long-term survival, continuous-time analyses demonstrated certain times during the day were associated with favorable short-term survival.

[CITATION]: Choi K, Altarabsheh SE, Saddoughi SA, et al. Impact of time of Day on Surgical Outcomes after Lung Transplantation (Night-time lung transplant). Ann Thorac Surg. 2024 Aug 30:S0003-4975(24)00698-2.

[DOI]: 10.1016/j.athoracsur.2024.08.013.

[IF]: 3.6