新型冠状病毒阳性供体对心脏移植受者预后影响的系统评价与Meta分析

Impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients:A systematic review and meta-analysis

目的评价新型冠状病毒(新冠)阳性供体对心脏移植受者预后的影响。方法计算机检索Medline、EMbase、CENTRAL、中国知网、万方、维普和中国生物医学文献数据库关于新冠阳性供体对心脏移植受者预后影响的文献,检索时限为建库至2023年5月。筛选及提取数据后,使用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行质量评价,Stata 11.0软件的metan模块进行Meta分析。结果筛选后纳入10项研究,共643例接受新冠阳性供体的心脏移植受者,NOS评分为5~9分。Meta分析结果显示,接受新冠阳性供体的心脏移植受者合并死亡率为4%[95%CI(2%,5%)];将移植失败、排斥和死亡作为预后不良的复合结局,复合结局发生率为7%[95%CI(5%,9%)]。与接受新冠阴性供体的心脏移植受者相比,新冠阳性供体的移植受者死亡事件合并OR值为0.68[95%CI(0.38,1.22),Z=1.28,P=0.200];排斥事件合并OR值为0.41[95%CI(0.27,0.64),Z=3.97,P<0.005];在复合结局方面,合并OR值为0.50[95%CI(0.37,0.69),Z=4.30,P<0.005]。两者住院时间差异无统计学意义[SMD=–0.03,95%CI(–0.22,0.15),Z=0.36,P=0.720]。结论现有研究证据表明,使用新冠阳性供者的心脏移植安全可行,但未来需要前瞻性、随访时间更长的研究来进一步确定其对长期预后的影响。

Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients.Methods The Medline,EMbase,CENTRAL,CNKI,Wanfang Data,VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients.The data were extracted from all the relevant literatures,and the quality of the data was assessed using the Newcastle-Ottawa Scale(NOS).All statistical analyses were conducted by the Stata 11.0 software.Results A total of 10 studies(NOS score ranging from 5 to 9 points)involving 643 patients were enrolled.The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4%(95%CI 2%to 5%).And the incidence of composite outcome,regarding graft failure,rejection and death as poor prognosis,was 7%(95%CI 5%to 9%).Besides,compared with recipients from SARS-CoV-2-negative donors,the pooled odds ratio(OR)value of death of SARS-CoV-2-positive donors was 0.68(95%CI 0.38 to 1.22,Z=1.28,P=0.200).The pooled OR value of rejection rate was 0.41(95%CI 0.27 to 0.64,Z=3.97,P<0.005).For the composite outcome,the pooled OR value was 0.50(95%CI 0.37 to 0.69,Z=4.30,P<0.005).In addition,there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors(SMD=–0.03,95%CI–0.22 to 0.15,Z=0.36,P=0.720).Conclusion The application of heart from SARSCoV-2-positive donor for transplantation is safe and feasible.However,further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.