Edwards N M, Rajasinghe H A, John R, Chen J M, Itescu S, Mancini D M
Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Clin Transpl. 1999:249-61.
Since 1977, the cardiac transplantation program at Columbia has performed 1,137 heart transplant operations with a current one-year survival rate of approximately 90% and a 5-year survival rate of approximately 75% representing the largest single institution experience in North America. Over 2 decades of experience in the selection of donors and recipients has permitted us to expand eligibility limits and relax conventional exclusion criteria allowing us to transplant high-risk donors and medically complex recipients with excellent results. Recipient characteristics, rather than those of the donor, substantially impact outcome following OHT and use of extended donors will improve allocation of donor organs particularly with marginal recipients. During the 2-decade long evolution in our transplant experience, substantial improvements have been made in the areas of immunosuppression, treatment of rejection, and handling of sensitized recipients. Frequent causes of late mortality such as graft rejection, infection, malignancy, and TCAD, have been significantly diminished in the modern area of immune manipulation but remain major causes of death and barriers to long-term survival. The single biggest impediment to growth in OHT is the shortage of donor organs. We have attempted to address this issue by identifying patients who may be better served with a bridging surgical procedure such as a mechanical assist device, or alternative procedures such as transmyocardial laser revascularization, high-risk reparative surgery, or myocardial volume reduction operations. Ongoing research interests at Columbia including LVADs, immunologic sensitization, xenotransplantation, and vasculogenesis offer the potential for continued growth for treatment of end-stage heart disease into the next millennium.
自1977年以来，哥伦比亚大学的心脏移植项目已进行了1137例心脏移植手术，目前的一年生存率约为90%，五年生存率约为75%，这代表了北美最大的单一机构经验。二十多年来在供体和受体选择方面的经验使我们能够扩大合格标准并放宽传统的排除标准，从而能够移植高风险供体和病情复杂的受体，并取得了优异的效果。受体特征而非供体特征对心脏移植术后的结果有重大影响，使用边缘供体将改善供体器官的分配，特别是对于边缘受体。在我们长达二十年的移植经验发展过程中，免疫抑制、排斥反应治疗和致敏受体处理等领域取得了显著进展。在现代免疫调控领域，移植物排斥、感染、恶性肿瘤和移植冠状动脉疾病等常见的晚期死亡原因已显著减少，但仍然是主要的死亡原因和长期生存的障碍。心脏移植增长的最大障碍是供体器官短缺。我们试图通过确定哪些患者可能更适合采用如机械辅助装置等过渡性手术程序，或如经心肌激光血运重建、高风险修复手术或心肌减容手术等替代程序来解决这个问题。哥伦比亚大学目前的研究兴趣包括左心室辅助装置、免疫致敏、异种移植和血管生成，这为下一世纪终末期心脏病的治疗持续发展提供了潜力。
