Novel Methods to Grow the Impact of Pediatric Thoracic Transplantation

提高儿童胸廓移植影响的新方法

• 批准号: 10186802
• 负责人: David L Morales
• 金额: $ 65.34万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186802
• 关键词: 3-Dimensional; Adult; Benefits and Risks; Cardiac Volume; Chest; Child; Childhood; Clinical Research; Communities; Data; Data Set; Development; Donor person; Effectiveness; Funding; Goals; Heart; Heart Transplantation; Heart-Lung Transplantation; Height; Image; Kidney Transplantation; Knowledge; Life; Lung; Lung Transplantation; Measurement; Methods; Modeling; Organ; Organ Size; Outcome; Patients; Pediatric Hospitals; Policies; Population; Population Sizes; Procedures; Research Personnel; Risk; Sampling; Savings; Standardization; Three-Dimensional Image; Three-Dimensional Imaging; Time; Transplant Recipients; Transplantation; United Network for Organ Sharing; United States National Institutes of Health; Virtual Tool; Wait Time; Waiting Lists; Weight; Work; base; care systems; clinical practice; cohort; design; end-stage organ failure; high risk; human old age (65+); improved; innovation; lung volume; member; models and simulation; mortality; novel; pediatric patients; post-transplant; reconstruction; risk stratification; tool; ventricular assist device; virtual; virtual surgery; 3-Dimensional; Adult; Benefits and Risks; Cardiac Volume; Chest; Child; Childhood; Clinical Research; Communities; Data; Data Set; Development; Donor person; Effectiveness; Funding; Goals; Heart; Heart Transplantation; Heart-Lung Transplantation; Height; Image; Kidney Transplantation; Knowledge; Life; Lung; Lung Transplantation; Measurement; Methods; Modeling; Organ; Organ Size; Outcome; Patients; Pediatric Hospitals; Policies; Population; Population Sizes; Procedures; Research Personnel; Risk; Sampling; Savings; Standardization; Three-Dimensional Image; Three-Dimensional Imaging; Time; Transplant Recipients; Transplantation; United Network for Organ Sharing; United States National Institutes of Health; Virtual Tool; Wait Time; Waiting Lists; Weight; Work; base; care systems; clinical practice; cohort; design; end-stage organ failure; high risk; human old age (65+); improved; innovation; lung volume; member; models and simulation; mortality; novel; pediatric patients; post-transplant; reconstruction; risk stratification; tool; ventricular assist device; virtual; virtual surgery

Project Summary/Abstract: Pediatric patients in need of thoracic (heart or lung) transplantation suffer unacceptably high mortality on the waitlist, even when there are significant number of donors that go unutilized. Many donors that are determined high-risk and wasted could benefit high-risk recipients that are more likely to die waiting. We propose (Aim 1) development of an innovative risk-based matching of donor and recipient. This will be achieved by developing pediatric specific, donor and recipient risk scoring models for heart and lung transplantation. Risk stratification derived from the scores will then be used in simulation-based models to identify best matching strategy that could deliver optimal overall outcomes for the transplant community (more patients transplanted, shorter waiting time, reduce wait-list mortality and more years of life post-transplant for the community as a whole). Furthermore, pediatric thoracic transplant community is still using an age-old method of weight/height-based donor to recipient size matching which leads to significant number of donors being refused for size mismatch. We also propose (Aim 2) development of in innovative and universally accessible tool for virtual matching of organ size rather than patient size to improve size matching for pediatric thoracic transplantation. This will include development of validated tools for cardiac and lung volume estimation and a clinical study to demonstrate potential benefits of the tool in pediatric heart and lung transplant candidates. Our team has gathered preliminary data to support the premise and feasibility of this project and has the members representing diverse perspective and strengths needed for this project. At the end of this project, we will be able to demonstrate potential benefits of donor- recipient risk matching and organ sizing matching that could improve donor utilization and reduce size mismatch and ultimately improve the impact of pediatric thoracic transplantation.

项目摘要/摘要： 需要胸腔（心脏或肺）移植的儿科患者在 候补名单，即使有大量的捐助者没有被禁用。许多确定的捐助者 高风险和浪费可能会使更有可能死亡的高风险接收者受益。我们提出（目标1） 开发基于风险的创新捐助者和接受者的匹配。这将通过开发来实现 儿科特异性，供体和受体风险评分模型，用于心脏和肺移植。风险分层 然后，从分数得出的基于仿真的模型将使用从分数中得出来确定最佳匹配策略 可以为移植社区提供最佳的总体结果（更多的患者移植，更短的等待 时间，降低候补名单死亡率，并在整个社区移植后移植更多年的生命）。此外， 儿科胸腔移植社区仍在使用一种古老的体重/基于高度的供体的方法 尺寸匹配导致大量捐助者因大小不匹配而被拒绝。我们也建议 （目标2）开发创新且普遍可访问的工具，以虚拟匹配器官大小而不是 患者尺寸以改善小儿胸腔移植的尺寸匹配。这将包括开发 经过验证的心脏和肺量估计工具以及一项临床研究，以证明 小儿心脏和肺移植候选者的工具。我们的团队收集了初步数据，以支持 该项目的前提和可行性，并让成员代表各种观点和优势 这个项目需要。在该项目结束时，我们将能够证明捐助者的潜在利益 接收者风险匹配和器官尺寸匹配可以改善供体利用并减少尺寸不匹配 并最终改善了小儿胸腔移植的影响。