Background

This study evaluates the clinical trends, risk factors, and effects of post-transplant stroke and subsequent functional independence on outcomes following orthotopic heart transplantation under the 2018 heart allocation system.

Methods

The UNOS registry was queried to identify adult recipients from 10/18/2018 to 12/31/2021. The cohort was stratified into two groups with and without post-transplant stroke. The incidence of post-transplant stroke was compared before and after the allocation policy change. Outcomes included post-transplant survival and complications. Multivariable logistic regression was performed to identify risk factors for post-transplant stroke. Sub-analysis was performed to evaluate the impact of functional independence among recipients with post-transplant stroke.

Results

A total of 9,039 recipients were analyzed in this study. The incidence of post-transplant stroke was higher following the policy change (3.8% vs 3.1%, p=0.017). 30-day (81.4% vs 97.7%) and 1-year (66.4% vs 92.5%) survival rates were substantially lower in the stroke cohort (p<0.001). The stroke cohort had a higher rate of post-transplant renal failure, longer hospital length of stay, and worse functional status. Multivariable analysis identified ECMO, durable LVAD, blood type O, and redo heart transplantation as strong predictors of post-transplant stroke. Preserved functional independence considerably improved 30-day (99.2% vs 61.2%) and 1-year (97.7% vs 47.4%) survival rates among the recipients with post-transplant stroke (p<0.001).

Conclusions

There is a higher incidence of post-transplant stroke under the 2018 allocation system, and it is associated with significantly worse post-transplant outcomes. However, post-transplant stroke recipients with preserved functional independence have improved survival, similar to those without post-transplant stroke.

中文翻译：

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移植后中风和随后的功能独立对 2018 年美国心脏分配系统下心脏移植后结果的影响

背景

本研究评估了2018年心脏分配系统下原位心脏移植后的临床趋势、危险因素和移植后卒中的影响以及随后的功能独立性对结果的影响。

方法

查询 UNOS 登记处以确定 2018 年 10 月 18 日至 2021 年 12 月 31 日期间的成人接收者。该队列被分为有和没有移植后中风的两组。比较分配政策改变前后的移植后卒中发生率。结果包括移植后存活和并发症。进行多变量逻辑回归以确定移植后卒中的危险因素。进行亚组分析以评估功能独立性对移植后卒中受体的影响。

结果

本研究共分析了 9,039 名接受者。政策变化后，移植后卒中的发生率更高（3.8% vs 3.1%，p=0.017）。卒中队列的 30 天（81.4% vs 97.7%）和 1 年（66.4% vs 92.5%）生存率显着较低（p<0.001）。卒中队列的移植后肾衰竭发生率较高，住院时间较长，功能状态较差。多变量分析确定 ECMO、持久 LVAD、O 型血和重新心脏移植是移植后卒中的强有力预测因素。保留功能独立性显着提高了移植后卒中受者的 30 天（99.2% vs 61.2%）和 1 年（97.7% vs 47.4%）生存率（p<0.001）。

结论

在2018年的分配制度下，移植后卒中的发生率较高，并且与明显较差的移植后结果相关。然而，与没有移植后中风的患者类似，保留功能独立性的移植后中风接受者的生存率有所提高。