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: 10661281
• 负责人: David L Morales
• 金额: $ 4.58万
• 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 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10661281
• 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

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）移植的儿科患者的死亡率高得令人无法接受 候补名单，即使有大量捐助者未得到利用。许多坚定的捐助者 高风险和浪费可能会使高风险接受者受益，因为他们更有可能在等待中死去。我们建议（目标1） 开发基于风险的创新捐赠者和接受者匹配。这将通过开发来实现 心肺移植的儿科特定供体和受体风险评分模型。风险分层 然后，从分数中得出的结果将用于基于模拟的模型，以确定最佳匹配策略 可以为移植界提供最佳的总体结果（移植的患者更多，等待时间更短） 时间，降低等待名单死亡率并延长整个社区移植后的寿命）。此外， 儿科胸腔移植界仍在使用一种古老的方法，即根据捐赠者的体重/身高向受者捐赠 尺寸匹配导致大量捐赠者因尺寸不匹配而被拒绝。我们还建议 （目标 2）开发创新且普遍可用的工具，用于器官大小的虚拟匹配，而不是 患者体型，以改善小儿胸腔移植的体型匹配。这将包括开发 经过验证的心脏和肺容量估计工具以及证明潜在益处的临床研究 儿科心脏和肺移植候选人的工具。我们的团队已经收集了初步数据来支持 该项目的前提和可行性，并拥有代表不同观点和优势的成员 这个项目需要。在这个项目结束时，我们将能够展示捐助者的潜在好处 受体风险匹配和器官尺寸匹配可以提高捐赠者的利用率并减少尺寸不匹配 最终提高小儿胸腔移植的效果。

项目成果

A novel method of donor‒recipient size matching in pediatric heart transplantation: A total cardiac volume‒predictive model.

儿科心脏移植中供体与受体尺寸匹配的新方法：心脏总体积预测模型。

• 发表时间: 2021-02
• 作者: Szugye, Nicholas A;Zafar, Farhan;Ollberding, Nicholas J;Villa, Chet;Lorts, Angela;Taylor, Michael D;Morales, David L S;Moore, Ryan A
• 通讯作者: Moore, Ryan A

Echocardiography Provides a Reliable Estimate of Total Cardiac Volume for Pediatric Heart Transplantation.

超声心动图为儿科心脏移植提供了总心脏容量的可靠估计。

• 发表时间: 2023-02
• 作者: Szugye, Nicholas A;Shuler, Jeffrey M;Pradhan, Sarah;Plasencia, Jonathan D;Villa, Chet;Taylor, Michael;Lorts, Angela;Zafar, Farhan;Morales, David L S;Moore, Ryan A
• 通讯作者: Moore, Ryan A

Donation after circulatory death significantly reduces waitlist times while not changing post-heart transplant outcomes: A United Network for Organ Sharing Analysis.

循环死亡后的捐赠显着减少了等待时间，同时不改变心脏移植后的结果：器官共享分析联合网络。

• 发表时间: 2024-03
• 作者: Ahmed, Hosam F;Kulshrestha, Kevin;Kennedy, John T;Gomez;Greenberg, Jason W;Hossain, Md Monir;Zhang, Yin;D'Alessandro, David A;John, Ranjit;Moazami, Nader;Chin, Clifford;Ashfaq, Awais;Zafar, Farhan;Morales, David L S
• 通讯作者: Morales, David L S

Donor considerations in pediatric heart transplantation.

儿科心脏移植中捐赠者的考虑因素。

• 发表时间: 2019-10
• 影响因子: 2
• 作者: Singh, Nikki;Raees, Muhammad Aanish;Zafar, Farhan
• 通讯作者: Zafar, Farhan

Infants Who Require Total Parenteral Nutrition and Paralytics at Time of Heart Transplant Experience Inferior Post-Transplant Mortality.

心脏移植时需要全肠外营养和麻痹药物的婴儿移植后死亡率较低。

• 发表时间: 2022-11
• 作者: Greenberg, Jason W;Tweddell, James S;Winlaw, David S;Lehenbauer, David G;Gist, Katja M;Chin, Clifford;Zafar, Farhan;Morales, David L S
• 通讯作者: Morales, David L S