CATCH: Creating Access to Transplant for Candidates who are High Risk

CATCH：为高风险候选人创造移植机会

基本信息

批准号：
10677626
负责人：
Meghan M Aversa
金额：
$ 39.87万
依托单位：
UNIVERSITY HEALTH NETWORK
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-05 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10677626
关键词：
Acute Respiratory Distress Syndrome Address Affect Age Body mass index Boston COVID-19 COVID-19/ARDS Caring Categories Cells Clinical Collaborations Complement Consensus Critical Illness Data Disadvantaged Disparity Donor person Eligibility Determination Ensure Exercise Extracorporeal Membrane Oxygenation Florida Future Goals Guidelines Health Hospitals Immunosuppression Improve Access Individual International Leadership Length of Stay Life Lung Lung Transplantation Lung diseases Mechanical ventilation Mechanics New York Operative Surgical Procedures Outcome Patient Participation Patient-Focused Outcomes Patients Perioperative Physical therapy Positioning Attribute Predictive Factor Procedures Process Prospective, cohort study Protocols documentation Pulmonology Quality of life Regimen Research Risk Sedation procedure Selection Criteria Site Standardization Thoracic Surgical Procedures Time Transplant Recipients Transplantation Uncertainty United States National Institutes of Health Universities Variant Waiting Lists Walking Woman access disparities antibody-mediated rejection candidate selection desensitization donor-specific antibody experience graft dysfunction health related quality of life high risk improved improved outcome mortality multidisciplinary organ allocation post-transplant programs transplant centers virtual willingness

项目摘要

PROJECT SUMMARY Today, lung transplantation for patients with end-stage lung disease has become increasingly standardized around the world, thanks to decades of international collaboration and partnership. As a result, more patients can receive a life-saving procedure and benefit from vastly improved survival and quality of life. However, access to lung transplant remains particularly variable for three categories of high-risk patients: 1) highly sensitized patients; 2) patients requiring extracorporeal membrane oxygenation support as a bridge to transplant (ECMO-BTT); and 3) patients with acute respiratory distress syndrome (ARDS, including those with COVID-19-associated ARDS). Because these patients are at high-risk for complications and historically understudied, there are no clear guidelines for their treatment. As a result, they are uniquely disadvantaged: receiving a transplant largely depends on their program’s willingness to accept the risk of transplant without sufficient data to inform how it can be optimally and safely performed. Programs, therefore, differ in the selection and management of these patients, creating significant disparities and variation in care across centers, ultimately to the detriment of the transplant candidate. With support from the NIH Lung Transplant Consortium, we propose the formation of CATCH: Creating Access to Transplant for Candidates who are High Risk, with the goal to improve access and outcomes for these patients in need. The four lung transplant programs that comprise CATCH—University Health Network, University of Florida, Columbia University, and Brigham and Women’s Hospital—collectively perform over 400 lung transplantations per year, and each have extensive but differing experience in managing these patients. Our CATCH study hypothesis is that our individual management strategies significantly impact high-risk candidates’ likelihood of receiving a transplant and their post-transplant outcomes. Through prospective cohort studies, we aim to devise an optimal and united strategy that addresses the specific unmet needs of these high risk patients. Our team has been carefully assembled based on scientific merit and strategic collaboration, representing multidisciplinary strengths in thoracic surgery and lung transplant pulmonology that will complement our recognized research leadership. We have extensive experience in successful project management for large multi-site projects, and our expertise in developing standardized protocols and consensus documents will help to maximize the potential across all transplant centers. Ultimately, as key opinion leaders in a field that actively looks to us for guidance, our CATCH project outcomes are strongly positioned to have an immediate transformative impact by standardizing the field and ensuring that every patient in need of a lung transplant can receive one.

项目概要如今，终末期肺病患者的肺移植已日趋标准化由于数十年的国际合作和伙伴关系，在世界各地获得了更多的患者。可以接受挽救生命的手术，并受益于大大提高的生存率和生活质量。然而，对于三类高危患者来说，获得肺移植的机会仍然存在很大差异：1) 高度敏感的患者；2) 需要体外膜肺氧合支持作为桥梁的患者；移植（ECMO-BTT）；和 3) 急性呼吸窘迫综合征（ARDS，包括患有以下疾病的患者）因为这些患者出现并发症和历史病史的风险很高。由于研究不足，没有明确的治疗指南，因此，他们处于独特的不利地位：接受移植很大程度上取决于他们的项目是否愿意接受移植的风险而无需因此，有足够的数据来告知如何以最佳方式安全地执行该程序。这些患者的选择和管理，造成了护理方面的巨大差异和差异中心，最终损害移植候选者的利益。在 NIH 肺移植联盟的支持下，我们建议成立 CATCH：创造机会为高风险候选人进行移植，目标是改善这些人的移植机会和结果 CATCH 大学健康网络组成的四个肺移植项目，佛罗里达大学、哥伦比亚大学和布莱根妇女医院 — 总共进行了 400 多项每年进行肺移植，每个人在治疗这些患者方面都有丰富但不同的经验。我们的 CATCH 研究假设是，我们的个人管理策略会显着影响高风险候选人接受移植的可能性及其移植后的结果。队列研究，我们的目标是制定一个最佳的、统一的策略，解决未满足的具体需求这些高危患者。我们的团队是根据科学价值和战略合作精心组建的，代表胸外科和肺移植肺科的多学科优势将补充我们的我们在成功的大型项目管理方面拥有丰富的经验。多站点项目，以及我们在开发标准化协议和共识文件方面的专业知识将有助于最终，最大限度地发挥所有移植中心的潜力，成为积极活跃的领域的关键意见领袖。期待我们的指导，我们的 CATCH 项目成果非常有利于立即产生影响通过标准化该领域并确保每位需要肺移植的患者获得变革性影响可以收到一份。